iMedical Anatomical Services | Tissue order form

Tissue request details

Quote number If iMedical has already quoted this order. Leave blank and a reference is created when you submit.

Shipping state

Requested date of tissue arrival

Requested time of tissue arrival

to

Tissue arrival time / arrival instructions

Tissue use Please describe in detail the use case for the requested tissue.

Tissue criteria Donor, anatomy, screening, packaging and documentation requirements.

Camera usage?

Yes No

Imaging requested? Additional fees will apply and imaging is subject to scanning availability.

Yes No

PO number

Ready-at date

Ready-at time

Date of tissue use

Disposition date

Contact information for disposition facility Name and phone number.

Address of disposition facility

Digital signature Type your full name.

Products in order

Select each tissue specimen from the iMedical Core Specimen Descriptions catalogue (2026 edition) — view the illustrated catalogue (PDF).

Tissue specimen	Quantity	Remove

Additional products in order

Optional. Supplies or services that are not catalogue specimens.

Product name	Quantity	Remove

Signature details

Customer signature The date and time are added when you submit the order.

iMedical signature and date
Completed by iMedical when the order is accepted.

Delivery details

Ship to Institution / organisation Attention / contact name Address line 1 Address line 2 City Postal code State / province / region Country Phone Email

Bill to Same as ship to Institution / organisation Attention / contact name Address line 1 Address line 2 City Postal code State / province / region Country Phone