Form

Zollege Supply Order Form

Please read the form fully and complete the applicable sections as necessary to submit a request for supplies to be sent to your school.

First Name*

Last Name*

Email*

Phone number*

Please select any and all that apply in the below section.

Medical Lab Equipment - CLIA Waived Lab Tests

QuStick Rapid Test Strep A(HS)

Clarity HCG Urine Test(HS)

Specimen Cup with lid, Non sterile 4oz.(HS)

Status Flu A&B Test Kit(HS)

Chemstrip Urinalysis Test Strips(HS)

Relion Glucose Test Strips (HS)

Obstetrical Antiseptic Wipes 100/Ct

Medical Lab Equipment - Sharps/Injectables

BD Eclipse Safety Needle 25g 1" (HS)

BD Eclipse Safety Needle 25g 1-1/2" (HS)

Syringe with Safety Needle 3cc 23g x 1" (HS)

TB Syringe with 27gx1/2" Needle (HS)

Insulin Syringe 1cc 29g 1/2" (HS)

Lancet 30g 1.5mm (HS)

Sharps Container 5.4qt

Alcohol Prep Pads

Medical Lab Equipment - Sterile Gloves

Sterile Gloves - 6 1/2 (Supply Room)

Sterile Gloves - 7 (Supply Room)

Sterile Gloves - 7 1/2 (Supply Room)

Medical Supplies

Please provide the number needed for each item you selected.

If you do not tell us how many or much that you need, your items will not be ordered.

Please designate how many of the below items are needed.

If the item is not needed, please leave blank.

Medical Replacement Item - Stethoscope(HS)

Medical Replacement Item - Teaching Stethoscope(Amazon)

Medical Replacement Item - Henry Schein Essentials Lg Adult

Medical Replacement Item - Henry Schein Essentials Adult

Medical Replacement Item - Henry Schein Essentials Pediatric

Medical Replacement Item - Otoscope(Amazon)

Medical Replacement Item - EKG Machine(Supply Room)

Medical Replacement Item - Braun Thermoscan(Amazon)

Medical Replacement Item - Welch Allyn Thermometer(Medex)

Medical Replacement Item - Henry Schein Adtemp Thermometer Oral

Medical Replacement Item - Exergen Temporal Thermometer(Amazon))

Medical Replacement Item - Ear Syringe 60mL(Supply Room)

Medical Replacement Item - ReliOn Glucometer(Supply Room)

Medical Replacement Item - Pulse Ox(Amazon)

Medical Replacement Item - Mosquito Forceps(Supply Room)

Medical Replacement Item - Ace Wraps(Supply Room)