Newborn Screening Testing - Supplies Order Form

Shipping Contact Information

* First Name

* Last Name

* Agency/Facility Name

* Street Address (P.O. boxes not permitted)

IMPORTANT -- Enter Suite, Floor Number, or Lab

Large hospitals: Designate the FLOOR,
or LABORATORY here, so the order is not lost internally when delivered.

* City

* State

(Other state name)

* Zip Code

* Phone Number

E-mail Address (for follow-up regarding your order)

Confirm E-mail & receive order receipt

Practitioners who use the Colorado Department of Public Health and Environment
Newborn Screening Laboratory services are not charged for supplies.

Orders are limited to three months supply of materials.

The Laboratory Services Division reserves the right to change
the requested amounts on the order, due to availability of supplies.

Supply Item Quantity Description

Double NBS Form
(1st and 2nd screens)

PLEASE NOTE:

1 CASE/BOX of first screen (double) cards
now contains 800 newborn screening cards.

If you order by the case or box, please indicate the words "case" or "box" with your order number and adjust your ordering number accordingly to eliminate the risk of having expired cards at your facility due to overstock.

Note: If you order smaller quantities of cards, you may still designate the smaller number in the entry field below, be sure to not use the words "case" or "box" with your smaller order.

Supplemental NBS Form
(2nd screen)
For doctors' offices or
clinics in CO/WY
or
non-Colorado/Wyoming
birthing facilities.

Pre-addressed Newborn Screening envelopes

Newborn Screening brochures for parents (English version)
*Quantities are limited. Please print the brochure from the link
below if your facility has this capability.

Newborn Screening brochures for parents (Spanish version)
*Quantities are limited. Please print the brochure from the link
below if your facility has this capability.

Brochures mailed from the CDPHE Laboratory
are temporarily being supplied in black and white print.

Click here to view and print the Newborn Screening brochure for parents. (English)

Click here to view and print the Newborn Screening brochure for parents. (Spanish)

Comments:

Request a FedEx Tracking Number by checking below
(Valid E-mail address is required)

E-MAIL a FEDEX TRACKING NUMBER

Contact the Newborn Screening Laboratory

For any additional requests of the Newborn Screening laboratory,
please contact the lab via e-mail at: cdphe.lab@cdphe.state.co.us
or by phone at: 303-692-3670

Click the submit button below to complete your order.
If you do not click the submit button, your order will not be received or fulfilled.

* Indicates Response Required