Single Order Form - Medical Supplies

Note: This order form is applicable only for individual orders. For bulk orders or orders of more than two the same item(s) please use the free formatted Order Form on the right side panel or click here.

Subject: * Single Order - Medical Supplies Prefix: Mr.Mrs.MissMs.Dr. First Name: * Last Name: * Phone Number: * E-mail Address: * Street Address: * Address Line 2: City/Town: * Province: * Postal Code: * Type of Merchandise to Order: * Medical Supplies Items to Order Alcohol Lamp Aneroid Sphygmomanometer - ALP K2 Japan Aneroid Sphygmomanometer - Baxtel Taiwan Aneroid Sphygmomanometer - Optimum China Aneroid Sphygmomanometer - 3M Baby Scale/ Spring Balance Cord Clamp Cotton Applicator Cotton Balls Cotton Canister Face Mask Face Towel Gauze Bandage Glass Slide Hot Water Bag Ice Bag Kidney Basin Medicine Cup Medicine Dropper Medicine Tray Needle G19 Needle G22 Needle G23 Needle G25 Oral Thermometer OS Dressing 2x4 OS Dressing 4x4 Penlight with Battery Rectal Thermometer Rubber Aspirator Specimen Bottle Stethoscope - ALPK2 Japan Stethoscope - Baxtel Taiwan Stethoscope - China Stethoscope - 3M Surgical Gloves Surgical Tape Syringe 1 cc Syringe 3 cc Syringe 5 cc Tape Measure Test Tube - 10 ml Test Tube - 5 ml Test Tube Holder Tongue Depressor Tourniquet Transpore Tape Laboratory Gown - Small Laboratory Gown - Medium Laboratory Gown - Large Laboratory Gown - Extra Large O.R. Gown Scrub Suit Plain - Small Scrub Suit Plain - Medium Scrub Suit Plain - Large Scrub Suit Colored - Small Scrub Suit Colored - Medium Scrub Suit Colored - Large Surgical Cap Alcohol Swab Other Orders * By submitting this form, you hereby agree to the terms and conditions set forth by LG Medical Supplies. * Required