OC FIT-CHEK Product Order Form

Please use the form below to submit a request for additional OC FIT-CHEK supplies. Once submitted, a Polymedco representative will follow up with you to confirm your order and gather additional information.

*Required fields

Contact Information

* Name:

* Email:

* Phone:

* Address:

Address:

* City | * State

* Zip/Postal Code:

Account Information

* Facility Name:

* Account Number, CLIA Number or Physician License Number:

Product Information

* Choose the products of interest below:

iFOBT Complete Testing Kit	Sedrate Controls
iFOBT Mailing Packs	Point of Care Tests
Fit-Chek Reagents	Chemistry Reagents
Sedrate Tubes

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