Supply Order Form

Contact Information

Company *

First Name *

Last Name *

Phone Number *

Email Address *

Shipping Information

Must be a physical address as shipping carrier does not deliver to PO boxes

Company *

Attention *

Street Address *

Street Address 2

City *

State *

Zip *

Phone Number *

Shipping Speed *

Standard (7-10 business days)

Overnight (cut-off time 11:45 AM Eastern Time; not guaranteed)

Two-Day (cut-off time 11:45 AM Eastern Time; not guaranteed)

Shipping Account Number *

Please provide your FEDEX or UPS shipping account number to be billed for this shipment.
*Orders placed without providing a shipping account number will not be filled.

Supplies

Any orders exceeding 300 should contact Customer Service (customerservice@dsimed.com) for support

Order Type *

Federal (DOT)

Forensic (Non-DOT)

Hair (Non-DOT)

Oral (Non-DOT)

Federal (DOT) Supplies

Quest Account Number *

Site Code (This is a required field ONLY if your Company uses location site codes for billing purposes)

CCF Forms

Split Collection Kits

Alcohol Forms

Blue Human Exempt Stickers

Quest Clinical Paks

FedEx Lab Paks

FedEx Lenexa Shipping Labels

Forensic (Non-DOT) Supplies

Quest Account Number *

Site Code (This is a required field ONLY if your Company uses location site codes for billing purposes)

CCF Forms

Single Collection Kits

Split Collection Kits

Alcohol Forms

Blue Human Exempt Stickers

Quest Clinical Paks

FedEx Lab Paks

FedEx Lenexa Shipping Labels

Hair (Non-DOT) Supplies

Quest Account Number *

Site Code (This is a required field ONLY if your Company uses location site codes for billing purposes)

CCF Forms

Collection Kits

Quest Clinical Paks

FedEx Lab Paks

FedEx Lenexa Shipping Labels

Oral (Non-DOT) Supplies

ORAL DEVICES ARE NOT APPROVED FOR DOT TESTING AT THIS TIME

Quest Account Number *

Site Code (This is a required field ONLY if your Company uses location site codes for billing purposes)

CCF Forms

Quantisal™ Device Packs (5 each)

FedEx Lab Paks

FedEx Lenexa Shipping Labels

Click here to have collection site (shipping information) preprinted on the chain of custody form as the collection site location

Collection Site

Company *

Street Address *

City *

State *

Zip *

Phone Number *

Fax Number

Errors found. Please correct order before submitting.

Quest Supply Order Form for DSI Medical clients

We have enhanced our Supply Ordering page to give you the ability to order supplies for multiple accounts in a single order. You will now receive a confirmation email for all orders. If you have any questions related to supply ordering, please contact Customer Service.

Quest Diagnostics has advised that due to an increase in demand for Custody and Control Forms, the expected delivery time for supplies is 14 business days.

ORAL DEVICES ARE NOT APPROVED FOR DOT TESTING AT THIS TIME