Agency Kit Stock Ordering Form

This form should only be used to request replenishment of kit stock.

Note: If you are placing an order for consumers, please follow the handover and escalation process.

Instructions:

Complete your details
Select the required items
Specify the quantity for each item
Once completed, click the submit button

Please note that all orders are subject to review prior to processing.

Important Information:

Order processing will take 2-3 business days and includes any necessary approvals for $ value or quantities
Order shipping can take up to 3-4 business days to arrive to the destination
Please ensure you are taking responsibility for your own kit and ordering regularly to ensure you don’t run out of stock
The stock in the Adelaide Amplar office will only be for urgent need and only a few items available at a time. Stock levels will be kept low to ensure appropriate turnover

Clinician Details

First Name *

Last Name *

Agency *

Other please specify *

Email Address *

Phone Number *

Address *

Street address *

City *

State *

Postcode *

PO boxes and the Amplar Health office address are not acceptable.

Stock Order

Stock Order List

Please select the item to be ordered from the drop-down list and enter the required quantity.

To add another item, click “New Item.”

Please note:

All items have a pre-determined size/quantity, which is written in brackets in the item description. You will still need to select the quantity in the second drop-down.

For example:

Image title

If you have any queries regarding ordering or any of the items, please contact Agency Nursing: agencynursing@amplarhealth.com.au

Kit Items

Kit Item Description

Quantity

Wound Care Items

Wound Care Item Description

Quantity

IV Items

IV Item Description

Quantity

PPE Items

PPE Items Description

Quantity

Miscellaneous Items

Miscellaneous Item Description

Quantity