For Existing Customers Only

Please fill out the form below to request a new order of PharmChek® products. Your sales representative will immediately receive your request and process your order.

Your Information

First Name *

Last Name *

Name of Your Company / Agency *

Email *

Phone *

Your PharmChek® Account Number *

Order Details

Please note that each PharmChek Sweat Patch Kit contains the following:
PharmChek Sweat Patches, CoC forms, pre-addressed lab mailers, alcohol wipes, specimen bags, transport bags, and single-use tweezers.

Select Your Sales Representative *

PharmChek® Sweatpatch Kit - (N218) 50 count *

PharmChek® Transparent Overlay - 25 count *

SPARE Chain of Custody (CoC) Forms *

Chain of Custody Forms Are Included in the Kit

Shipping Information

Shipping Address *

City *

State *

Zip Code *

Type of Address *

Business Address

Residential Address

Please indicate whether the address provided above is a business or residence.

Additional Comments (optional)

If there's anything special about your order, please let your sales representative know.