Supply Order Form

Please complete the form below detailing your request and a member of our support staff will respond as soon as possible.

Order Date

Facility Information

Contact Name*
Is Shipping Address different than Collection Site Address?*

Shipping Preference

How would you like your order shipped?*
Please note: FedEx is our primary provider. If they are not available in your area, we will use Purolator or Canada Post.

Urine Drug Testing Supplies

Oral Fluid Drug Testing Supplies

Dynacare Lab Supplies

Psychemedics Lab Supplies

Alcohol Testing Supplies

Audiometric Testing Supplies

Spirometry Testing Supplies

Heart/Blood Pressure Supplies

WatchPat Supplies

Misc Occupational Testing Supplies

Additional Questions/Comments

If any supplies are not listed above, or if you have additional comments or questions, please add to the form below.

All supplies I require are accurately accounted for and requested*
All of my current supply stocks expiry dates are within range*

National Network Approval

Status of supply request*
If you have any questions or concerns regarding the status of your request, please contact nationalnetwork@surehire.ca
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