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To learn how Alere Toxicology can build the ideal testing program for your organization, contact us at 800.340.4029 or email us for more information.

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Supply Request Form

If you are an existing customer with an active account that needs supplies, please complete our online request form below.

To best serve you, please use information that is associated with your account/contract and ensure that all fields are completed. Once submitted, a representative will contact you to finalize your request.

Please note that completing this form does NOT indicate a final order: you MUST speak with a representative to complete an order. Submitting this form will alert a representative to call you.

Customer Information * required field(s)

* First Name
* Last Name
* Company Name
Account Number
* Phone Number #
* Email Address
*Shipping Address 1
Shipping Address 2
*Shipping State
*Shipping Zip Code

Supplies Requested

Please select desired items and enter quantity. If you do not see the item(s) in which you are interested, please use the OTHER field to type in a description.

Urine Collection Supplies: Quantity

  • Single Kits
  • Split Kits
  • 60mL Bottles
  • 90mL Bottles (female)

Oral Fluid Collection Supplies: Quantity

  • Oral Fluid Collection Kits
  • Oral Fluid Shipping Supplies

Hair Collection Supplies: Quantity

  • Hair Collection Kits
  • Hair Shipping Supplies

Forms and Labels: Quantity

  • Non Federal COC / Requisition Forms
  • Federal COC Forms (DOT)
  • Urine Test Request Forms
  • Oral Fluid Test Request Forms
  • Hair Test Request Forms
  • Blood Test Request Forms
  • Electronic COC Barcode Labels

Shipping Supplies: Quantity

  • FedEx Supplies (labels and bags)
  • UPS Supplies (labels and bags)

Additional Supplies: Quantity

  • Specimen Bags
  • Clear Specimen Bags
  • Other:

Special Instructions:


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Alere Toxicology Locations

With a global presence, Alere Toxicology connects you with the information and resources needed to empower smart health choices, and positively impact health worldwide.

Our Locations »