School Nurse Supply Order Form

If you would prefer a paper copy to either mail or fax in your order to us, then please use this form for all of your ordering needs.

Order Form

Return Form

School Nurse Supply guarantees your satisfaction on all products received from our company within 60 days of purchase.  Use this Return Form when you are making a product return or exchange.  All returns are subject to review and require prior authorization from our Return Department.

Return Form (PDF)

Calibration & Repair Order Form

Use this Repair Form when you are sending in equipment for repair.  All repairs are subject to review and require prior authorization from our Repair Department.  Please contact Customer Service Department at 800-485-2737 for complete instructions. 

Repair Form (PDF)

Medical Authorization Form

The Medical Prescription/Authorization Form is required at the time of purchase when filling a prescription for and Automated External Defibrillator (AED), as well as all pediatric pads.  AEDs are FDA regulated medical devices.  A prescription to acquire the unit from a board-certified physician in the state the unit will be located in is required by federal regulation.  In addition, a licensed physician or medical authority will ensure that all designated responders are properly trained; that the AED is properly maintained; and that the program meets all requirements, which may vary from state to state.

Medical Authorization Form (PDF)

W-9 Form

Print this W-9 form with our information to be signed for your tax purposes.

W-9 Form (PDF)

New Clinic Start-Up List

This form lists all of the essential products that you will need to help get a new clinic up and running.

New Clinic Start-Up List

Barjan Custom Cubicle Curtains Questionnaire

Create a more private and professional look in any space.  Simply fill out the attached questionnaire to diagram your track layout and curtain configuration.

Barjan Questionnaire (PDF)

Vendor Trade-in Forms

Some of our vendors offer customers rebates on their old equipment as an incentive to update to a newer model.

Optec $350 Trade-In Rebate Form

Stereo Optical is offering a $350 rebate when you trade-in your old vision screener for a NEW Optec 5000 or 5500 Vision Screener.

plusoptiX S20 Trade-In Form

Plusoptix is offering a trade in when you purchase the new plusoptiX S20 Vision Screener.

Welch Allyn $1,000 Spot Trade-In Form

Welch Allyn is offering a $1,000 rebate when you trade in your old vision screener for a NEW Spot Vision Screener.

Titmus $300 Vision Screener Trade-In Form

Titmus is pleased to offer customers in the United States, for a limited time, a manufacturer's Trade-In Allowance towards the purchase of a NEW Titmus Vision Screener (Titmus V2 or Titmus V4).

ZOLL Trade-In Coupon

ZOLL is offering an AED trade-in program to assist in your purchase of a new AED unit.