IBL Supply Order Request Form
For questions or help with this form, contact IBLSUPORD@dhw.idaho.gov or (208)334-0503.
*Supplies sent with a requested courier are at the cost of the entity requesting the samples.
The Idaho Bureau of Laboratories (IBL) provides selected supplies as no cost, with the understanding that the supplies will be used for submitting samples to IBL for testing.  
The following items are free of charge for CLINICAL testing (unit of measure = each):
IBL Use Only:

Section/PCA:  ______________________                            Date shipped:  __________________________

Shipper used:  _____________________                             Certified by IBL employee:  ________________
Revised 7/5/2018
The following items are free of charge for WATER testing (unit of measure = each):
Please complete the following information (required).
Please complete the following information (required).
Notes pertinent to your order
Notes pertinent to your order
Requested supplies to be sent via:
Requested supplies to be sent via:
Date of pick up
Date of pick up
Name of courier
Name of courier
Date of pick up
Date of pick up