Pricing $20.00 analysis without photographs $25.00 analysis with 2 color photographs $29.00 analysis with 3 color photographs  effective March 01 2008

Existing customers may download the following ADOBE PDF file to submit with your specimen. Please fill in the patient information that you want to show in your final report. In the lower box on the left hand side, please put your customer account number, address and contact Name, and phone number. Mail to our P.O. Box located on the top of the form. Specimen Requisition

Free Shipping Supplies - Please fill out the following form and submit. Supplies will be shipped within 24 hours. PLEASE NOTE THAT QUANTITY MAY BE BASED ON YOUR YEARLY HISTORY. The fields marked with (*) are required fields. * Client Name and or Account no.  * required * Phone Number  * required * Contact Person  * required * Requisition Forms Qty 8 20 40 80 100 200 300 400 500 * Specimen Containers Qty 8 20 40 80 100 200 300 400 500 * Shipping Bags Qty 8 10 20 40 80 100 200 300 400 500   Special Shipping Instructions or address changes

SHIPPING INSTRUCTIONS   Your specimen should never be sent wet. Each specimen should be put in our smaller inner vial unless your specimen is to large for this vial. You should mark the smaller inner vial with patient information. either name or specimen number, but preferably both. DO NOT LABEL OR WRITE ON THE SECONDARY CONTAINER.  ONCE YOUR SPECIMEN ARRIVES IN OUR LABORATORY IT IS REMOVED FROM THIS CONTAINER IMMEDIATELY. If you are mailing more than one specimen at a time you may put up to 8 bottles in a bag. However, we strongly suggest you double bag to prevent specimen loss. You do not have to use or wait for our supplies in order to ship your specimen to us. To meet USPS Mailability specification, specimens must be double packaged, then placed in a suitable outer container for shipping. Please drain you specimens of any liquid / blood / urine Do not ship your specimen in formalin If your specimen is in a glass tube, do not send this specimen in a standard business envelope If you have any questions please call us at 1-800-235-4846 from 8:00 to 4:00 cst. Urolithiasis Laboratory 9525 Katy Frwy Suite 222 Houston Texas 77024