Sample Request
Your Name *
Job Title / Role *
Job Location *
Address *
Postcode *
Country *
United KingdomUSA / Canada
Telephone *
Email *
Model *
PE40: with 30ml Universal ContainerPE41: as above with Boric Acid preservativePE50: with 10ml Primary Tube (lab-compatible)PE51: as above with Boric Acid preservative
NHS Trust / CCG or Private Healthcare Provider
-- Select an OptionNHS Trust / CCGPrivate Healthcare Provider
Name of Trust or Provider *
