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* MM slash DD slash YYYY Account #* Name* First Last Phone*Address* Street Address Address Line 2 City State ZIP / Postal Code BagsBiohazard Bags w/Pocket QuantityStandard Size Price: $0.00 Quantity Bags - Large QuantityLarge Price: $0.00 Quantity FormalinNeutral Buffered 10% Quantity20 ml Price: $0.00 Quantity Neutral Buffered 10% Quantity40 ml Price: $0.00 Quantity Neutral Buffered 10% Quantity60 ml Price: $0.00 Quantity OtherMichel's Fixative Quantity60 ml Price: $0.00 Quantity Shipping SuppliesFedEx Shipping Clinic (U3373) Paks Quantity Price: $0.00 Quantity FedEx Shipping Box (M) Quantity Price: $0.00 Quantity FedEx Shipping Airbill Quantity60 ml Price: $0.00 Quantity UPS Shipping Lab Pak Quantity60 ml Price: $0.00 Quantity UPS Shipping Box (M) Quantity60 ml Price: $0.00 Quantity UPS Shipping Airbill Quantity Price: $0.00 Quantity Lock Box Quantity60 ml Price: $0.00 Quantity Slide HoldersPlastic Quantity Price: $0.00 Quantity Cardboard QuantitySmall Price: $0.00 Quantity Cardboard QuantityLarge 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.