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Clinical Affairs - Materials Management



Central Sterilization Order Form


Orders should be received no later than 5:00 PM the day prior to date needed. Orders are filled on a first come first serve basis.

(* Required Items)

Department/Clinic*:
Room #*:
Contact*:
Email Address*:
Phone*:
Date Needed*: (i.e. 01/01/10)
Time Needed*: (i.e. 8:00 am)
Remember Me:

 

CASSETTES     (Enter Quantity Required,
               leave field blank if you don't want any)		 # items currently
Checked out
#1 Exam
#2 Scaling
#5 Crown and Bridge
#6 Endodontic
#7 Pediatric Operative
#8 Pediatric Recall
#9 Pediatric Scaling
OP Operative
RP Removable Prosthodontics
RD Rubber Dam
OT Other

HANDPIECES     (Enter Quantity Required, leave field blank if you don't want any)

Highspeed
Slowspeed
Straight
Latch

BURS     (Enter Quantity Required, leave field blank if you don't want any)

E-Cutter
Amalgam/Polish
Polish
Crown
Composite

ULTRASONIC TIPS     (Enter Quantity Required, leave field blank if you don't want any)

Blue
Black
3 pk. Cassette

GOWNS
(Enter Quantity Required, please order by the bundle, one bundle = @ 20 gowns, leave field blank if you don't want any)

# of Gown Bundles

TOWELS     (Enter Quantity Required, leave field blank if you don't want any)

# of Towels

COMMENTS
(Leave blank if no comments)