Repromedix - Helping Doctors Help Couples
For Clinicians
how to order tests

Specimen Materials Request Form

Please fill out and submit the Specimen Materials Request Form below. If you prefer to fax it to us, download the form via PDF and fax to (781) 937-8895. We will ship the supplies to you directly.

TO: Repromedix

FROM:

ADDRESS:

CITY:

STATE: ZIP:

I need these supplies: ASAP 2-3 days no rush

Small specimen packs - 3 tube holder
Large specimen packs - 8 tube holder
SDD/YCMD 3.0 client kits
Male ASA test kits with TYB
FedEx Diagnostic bags
Green top Vacutainer tubes
Blue top Vacutainer tubes
Red/Tiger top Vacutainer tubes
Purple top Vacutainer tubes
Test requisition form
Specimen transportation instructions
Specimen requirement form
FedEx Air bill
4ml pour-off tubes
Pre-SDFA kits
Dry ice
Transfer pipettes

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Test Requisition Form

Specimen Requirements Chart

Specimen Materials Request Form

Sample Preparation and Submission