Supply Order Form

Name of Hospital:
City:
Name of Person Requesting:
Insert quantity required of each:
	SAF-T-PAKS
	Federal Express/Purulator Waybills
	Freezer Vials
	Shipping Media (Charcoal Swabs)
	Specimen Shipping Log Sheets
Should you require further information, please call us using our toll-free number 1-800-668-6292. Address: Mount Sinai Hospital, Microbiology Dept., 600 University Ave., Toronto, Ontario, M5G 1X5., or click here to email study office.