City of Alexandria, Virginia Not your city or county?

Tuesday, May 28th, 8am CDT: We are currently experiencing some telephone issues due to severe storms in the DFW area this morning. If your call is not answered please try again later today! Thank you.

Licensing Supply Order

Please complete the form below to order supplies free of charge. Most supply orders are delivered within 5 business days. If you require a rush, please check "Rush Delivery" below.

Your Name:
*
Email Address:
 
Clinic Name:
*
Contact Phone:
*
Clinic Address:
*
Clinic City, State, Zip:
 

Please send the following supplies:
      URGENT! - Please Rush Delivery
Monthly Reporting Envelopes  

Questions or Comments:
 
  * = Required
 

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