Dept. of Public Health (DPH) Newborn Screening Program Supply Order Form

Connecticut Newborn Screening Program
Supply Order Information

Please select the item(s) and the quantity needed for each item below. Items will generally be shipped within 2 business days of receipt of your order. If the quantity needed exceeds the quantity noted below or you require expedited shipping, please call 860.920.6674 or 860.920.6628.

Name of Facility or Practice Shipping Address Line 1 Shipping Address Line 2 City State Zip Code Type of Facility/Practice If Other, please specify

Contact Individual Name Contact Individual Title Contact Phone Email Address

Newborn Screening Program Supply Order Information

Please select the item(s) and the quantity of each item below. Please note there is a minimum order of 10 items, a maximum of 500 items, and items must be ordered in multiples of 10.

CT Newborn Screening Parent Fliers (English) Quantity CT Newborn Screening Parent Fliers (Spanish) Quantity CT NBS Program Filter Paper (Bloodspot Specimen) Cards Quantity Whatman 903 NBS Filter Paper Card Drying Rack Quantity Zebra Barcode Label Stickers for use with Zebra Printer Model GX420D Quantity Zebra Barcode Label Stickers for use with Zebra Printer Model 2844-TLP Quantity Please call the CT NBS Program at (860) 920-6628 to order a Zebra Barcode Label Printer.

The Connecticut Newborn Screening Program

Connecticut Newborn Screening Program Supply Order Information

Newborn Screening Program Supply Order Information

Connecticut Newborn Screening Program
Supply Order Information