Skip to content
UPLOAD IMAGE
PAY BILL
HOME
ABOUT
Company Overview
Our Management Team
Our Pathology Team
Podiatric Medical Advisory Board
Clinical Consultants – Podiatry Faculty
Find an Account Manager
Careers
FOR PHYSICIANS
SERVICES
Our Pathology Services
Anatomic Pathology
Molecular (PCR)
Microbiology
Specialized Neurology (ENFD)
PRODUCTS
Therapeutic Solutions
Biopsy Instruments
Bako Online Ordering Portal
RESOURCES
Resources
Instructional Videos
Order Lab Supplies
Find an Account Manager
Secure Image Upload
Cases and Report Portal
FOR PATIENTS
FOR PAYORS
LEARNING CENTER
Learning Center Overview
Instructional Videos
Podiatric Dermatology Fellowship Program
NEWS
CONTACT
Order Lab Supplies
Order Lab Supplies
mkulwiec
2017-12-12T16:01:45+00:00
Lab Supply Order Form
Account Information: *(required)
Site / Account Number
Physician Name
*
Address
*
City
*
State
*
Zip
*
Phone Number
*
Email address
*
Specimen Packing Supplies:
Biohazard Medium Bag – 6 x 9 inch (Pack of 50)
0
1
2
3
4
PACK(S)
Dry Keratin Specimen Bag (Pack of 50)
0
1
2
3
4
PACK(S)
Empty Specimen Transport Box – 2 Vial
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Empty Specimen Transport Box – 6 Vial
0
1
2
3
4
5
6
7
8
9
10
Transport Box Insert For Vials – 2 Vial
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Transport Box Insert For Vials – 6 Vial
0
1
2
3
4
5
6
7
8
9
10
20 mL Vials – EMPTY (pack of 25)
0
1
2
3
4
60 mL Sterile Vials – EMPTY (each)
0
1
2
3
4
5
6
7
8
9
10
Formalin Vials - 20 mL (Pack of 48)
0
1
2
3
4
Collection / Transport Kit – 2 Vial
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Includes 2 20 mL formalin containers, dry keratin bag, 6 x 6 biohazard bag.
Collection / Transport Kit – 6 Vial
0
1
2
3
4
5
6
7
8
9
10
Includes 6 20 mL formalin containers, dry keratin bag, 6 x 6 biohazard bag.
Epidermal Nerve Fiber Density Testing Kit – Single Biopsy Location
0
1
2
3
4
5
6
7
8
9
10
ENFD kits are sent with prepaid FedEx Clinical Paks and Airbills unless indicated in the Comments section below.
Epidermal Nerve Fiber Density Testing Kit – Dual Biopsy Locations
0
1
2
3
4
5
6
7
8
9
10
Epidermal Nerve Fiber Density DVD and Instructional Video
Aspiration Biopsy Kit – ETOH / Dehydrated Alcohol – 2 Vial
0
1
2
3
4
5
6
7
8
9
10
eSwabs (Order Individually) (Include swab letter)
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
EACH
Nail Unit / Keratin Analysis Kit
Contains 5 USPS Prepaid Mailers, 5 Dry Keratin Requisitions, 5 Dry Keratin Biohazard Bags.
Specimen Transport Supplies:
FedEx Clinical Pak (mailing bag)
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
EACH
FedEx Prepaid Airbills
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
EACH
UPS Clinical Pak (mailing bag)
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
EACH
UPS Prepaid Airbills
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
EACH
United States Postal Service Prepaid Dry Keratin Mailer
USPS Mailers are to be used for routine dry keratin specimens.
Forms
Podiatry Requisition Form
0
10
25
50
100
Dry Keratin Requisition Form
0
10
25
50
100
ENFD Requisition Form
0
10
25
50
100
Surgery Center & Family Practice Requisition Form
0
10
25
50
100
Dermatology Requisition Form
0
10
25
50
100
Supply Order Forms
Specimen Vial Labels (28 per sheet)
Comments
Captcha
Sign-up for the Bako Diagnostics Newsletter
