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 is 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.  Quantity limits for select supplies have been established.  Contact IBLSUPORD@dhw.idaho.gov or (208)334-0503 for more information.
The following items are free of charge for CLINICAL testing (unit of measure = each):
IBL Use Only:

PCA:  _________________________                                  Shipper used:  __________________________

Date supplies sent:  _____________________                     Initials of IBL sender:  ____________________
Revised 12/2015
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