Supply Request Form Dermatopathology Lab 4037 NW 86th Terrace Gainesville, FL 32606 Phone (352) 594-1935 Fax (352) 594-1504 Toll Free: 1 (855) 4UF SKIN (1-855 483-7546) UFHealth.org Dermatopathological Supply Request Form Date* Account #*Name* First Last Phone*Address* Street Address Address Line 2 City State ZIP / Postal Code BagsBiohazard Bags w/PocketStandard Size Price: $0.00 Quantity: Bags - LargeLarge Price: $0.00 Quantity: FormalinNeutral Buffered 10%20 ml Price: $0.00 Quantity: Neutral Buffered 10%40 ml Price: $0.00 Quantity: Neutral Buffered 10%60 ml Price: $0.00 Quantity: OtherMichel's Fixative60 ml Price: $0.00 Quantity: Shipping SuppliesFedEx Shipping Clinic (U3373) Paks Price: $0.00 Quantity: FedEx Shipping Box (M) Price: $0.00 Quantity: FedEx Shipping Airbill60 ml Price: $0.00 Quantity: UPS Shipping Lab Pak60 ml Price: $0.00 Quantity: UPS Shipping Box (M)60 ml Price: $0.00 Quantity: UPS Shipping Airbill Price: $0.00 Quantity: Lock Box60 ml Price: $0.00 Quantity: Slide HoldersPlastic Price: $0.00 Quantity: CardboardSmall Price: $0.00 Quantity: CardboardLarge Price: $0.00 Quantity: Patient Care – Research – Education UF Health is a collaboration of the University of Florida Health Sciences Center, Shands hospitals and other health care entities.