TOPS Biopsy Kit Order Form

Above: Biopsy Kit, Michel's Media Bottle, and Liquid-Based Brush Cytology Kit

To request complimentary Biopsy, Cytology, or Immunofluorescence Kits, please complete the form below and allow 3-5 business days for delivery.

Doctor’s first name

Doctor’s last name

Office/Practice name

Have you ordered kits from TOPS before?

Yes, I am a returning contributor.

No, this is my first time ordering.

Phone

Fax

Street Address

City

State

ZIP Code

Type of Kit(s)

Biopsy

Cytology

Immunofluorescence

Special Instructions (Optional):