Supply Request

Please ensure your facility has at least 6-8 weeks worth of supplies on-hand to prevent potential service interruptions. 

Order Date

Facility Information

The National Network staff can provide your NAV number. Please keep a record of this number to use on your supply orders to avoid delays.
Contact Name*
Collection Site Address*
Is Shipping Address different than Collection Site Address?*
Shipping 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.
Express shipping requests are subject to approval. If the items can arrive via ground/standard shipping within a reasonable time frame the express shipping request may be denied.
Overnight shipping requests are subject to approval. If the items can arrive via ground/standard shipping within a reasonable time frame the overnight shipping request may be denied.

Urine Drug Testing Supplies

Please order per panel (each box contains 25 panels)
Please order per panel (each box contains 25 panels)
Please order per panel (each box contains 25 panels)
Please order per panel (each box contains 25 panels)
Please order per cup (each box contains 100 cups)
Useful only for toilets with tanks, this bluing agent ensures the water is an obvious blue shade to assist with adulteration detection.
Please order per bottle (each bottle contains 25 strips)

Oral Fluid Express Drug Testing Supplies

Please order per kit.

Lab Supplies

Please order per kit (each box contains 100 kits).
Standard lab form for all Non-DOT testing.
Used for Department of Transportation lab collection clinics with DOT certified technicians.
Please order per kit.
Standard lab form for all lab-based oral fluid testing. Specimen numbers at the top of the form begin with OF.
Used for Department of Transportation breath alcohol testing at clinics with DOT certified technicians.
Purolator bags to ship lab samples to Dynacare.
Dynacare uses Purolator only. Waybills cannot be ordered alone, they must accompany lab supplies (split kits, Quantisals, etc)

Hair Lab Supplies

Psychemedics Only. Each kit contains an envelope, waybill, and lab form. Please order per kit.

Alcohol Testing Supplies

Please order per tube.
Gas cylinder used to complete a calibration check.
Please order per roll.

Audiometric Testing Supplies

Paper is specific to your audio printer. Please order per roll.
Given out along with the audio card after every audio appointment. Please order per pamphlet.
Please order per card.

Spirometry Testing Supplies

Disposal white turbine used for spirometry testing with a SpiroDoc.

Heart/Blood Pressure Supplies

CR2025 battery for the Polar A370 Heart Rate Monitor chest strap.
Small device placed on the finger to read blood oxygen levels.
Gauge used to calibrate the blood pressure machine.
Replacement coil tube for E-sphyg blood pressure machine.

Misc Cards

Please order per card.
Please order per card.

Additional Questions/Comments

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

I have reviewed my entire testing inventory and do not require additional supplies.*
Please ensure your clinic has 6-8 weeks of testing supplies on hand to prevent potential service interruptions.
All of my current supply stock's 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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