US Forest Service Medical Purchase Form Step 1 of 3 33% This field is hidden when viewing the formNext Steps: Install a Payment Add-OnTo accept payments on this form you will need to install one of our payment add-ons. To learn more about your payment add-on options, visit the following page (https://www.gravityforms.com/blog/payment-add-ons). Important: Delete this tip before you publish the form.US Forest Service Medical Unit 2025 “Serving the USFS for over 30 years” Supplies Order Form (Can ship the same day anywhere in the U.S.) Fax to (800) 842-2412 or call (800) 424-4410 Weekends and After hours contact: Bruce Houghton (714-686-5532) or Ted Jass Cell (714)227-0312 (24HRS) (SWA Same Day Air available) (After Hours call Cell):POISON OAK & IVY RELIEF, INSECT RELIEF:IVY-X Pre-Contact PO 4oz QuantityItem No: 10159 Price: $3.99 Quantity IVY-X Post-Contact PO 4oz QuantityItem No: 10164 Price: $3.99 Quantity Technu Extreme Tube 4oz QuantityItem No: 10423 Price: $13.65 Quantity Tecnu Rash Relief 6oz Spray QuantityItem No: 10421 Price: $13.75 Quantity Technu Cal-a-Gel Clear 6oz QuantityItem No: 10422 Price: $7.50 Quantity CalaGel Anti-Itch Gel 1/16 pk - 144ct QuantityItem No: 10420 Price: $24.75 Quantity Cortex Corrium Anti-itch Gel 6oz QuantityItem No: 10407 Price: $10.85 Quantity Zanfel 1oz Tube QuantityItem No: 10166 Price: $39.95 Quantity IVY-X Post-Contact Wipes QuantityItem No: 10651 - Case Qty: 300ct/cs Price: $152.15 Quantity IVY-X Pre Contact Wipes QuantityItem No: 10653 - Case Qty: 300ct/cs Price: $150.35 Quantity Bug-X Insect Towelettes QuantityItem No: 10654 - Case Qty: 100ct/cs Price: $75.11 Quantity Bug-X Insect Towelettes QuantityItem No: 10656 - Case Qty: 300ct/cs Price: $225.85 Quantity Cortex Deet Insect Repellent 2oz QuantityItem No: 10569 Price: $4.05 Quantity Insect Relief Wipes QuantityItem No: 10675 Price: $1.92 Quantity Calamine Lotion 6oz QuantityItem No: 10415 Price: $5.75 Quantity POISON OAK & IVY 3oz MULTI USE SOAP BAR QuantityItem No: 10163 Price: $8.00 Quantity POISON OAK&IVY 1oz SINGLE USE SOAP BAR QuantityItem No: 10165 Price: $6.00 Quantity FOOT RELIEF, CREAMS/SUNSCREEN, LIP BALM:Tolnaftate Foot Powder 1.5oz QuantityItem No: 10238 - Case Qty: NA Price: $5.45 Quantity Gold Bond Med Powder 4oz QuantityItem No: 10489 - Case Qty: 24/cs Price: $7.65 Quantity Gold Bond Med Foot Powder 4oz QuantityItem No: 10485 - Case Qty: 24/cs Price: $7.65 Quantity Body Glide Anti-Chafing Stick 1.3oz QuantityItem No: 10543 - Case Qty: NA Price: $8.46 Quantity SunX Sunscreen SPF 30 4oz QuantityItem No: 10561 Price: $4.50 Quantity Coretex Sunscreen Towelettes QuantityItem No: 10563 - Case Qty: NA Price: $39.95 Quantity Burn Ease Cooling Gel 1/8oz - 20CT QuantityItem No: 10660 Price: $4.86 Quantity Chap Ice Lip Balm QuantityItem No: 010 -CHAP Price: $0.99 Quantity SunX Lip Balm SPF30 QuantityItem No: 10413 Price: $1.45 Quantity Second Skin Circles 3” 48CT QuantityItem No: 10263 Price: $54.00 Quantity Second Skin Squares 200CT QuantityItem No: 10264 Price: $36.65 Quantity Moleskin 2” X 25yds Roll QuantityItem No: 10482 Price: $59.71 Quantity Moleskin 3” X 25yds Roll QuantityItem No: 10480 Price: $76.89 Quantity Hydrocortisone Cream 144 CT QuantityItem No: 10221 Price: $22.78 Quantity Aspercreme Analgesic 1.25oz QuantityItem No: 10211 Price: $6.92 Quantity ASSORTED BANDAGES, GAUZES, BANDAIDS:Sam Splint Roll 4-1/2”x36” QuantityItem No: 10527 Price: $32.37 Quantity Ace Wrap 2” x 5Yds Roll QuantityItem No: 10060 Price: $0.85 Quantity Ace Wrap 3” x 5yds Roll QuantityItem No: 10061 Price: $1.05 Quantity Ace Wrap 4” x 5yds Roll QuantityItem No: 10062 Price: $1.20 Quantity Hypafix White Tape 2" X 11yds QuantityItem No: 010-HYPA2 Price: $17.85 Quantity Hypafix White Tape 4" X 11yds QuantityItem No: 010-HYPA Price: $32.37 Quantity Coflex Self Adh Wrap 3”x5yds Rolls 24ct QuantityItem No: 10177 Price: $54.85 Quantity Coflex Self Adh Wrap 2”x5yds Rolls 36ct QuantityItem No: 10176 Price: $59.50 Quantity Woven 1”x3” Bandages QuantityItem No: 10088 - 100ct Box Price: $3.95 Quantity Band-Aids 1”x3” Plastic 100ct QuantityItem No: 10082 Price: $2.89 Quantity 2"X3" Bandages Elastic Patch QuantityItem No: 10100 - 100ct Box Price: $3.50 Quantity Woven Knuckle Bandages QuantityItem No: 10094 - 100ct Box Price: $8.65 Quantity Woven Fingertip Bandges QuantityItem No: 10096 - 100ct Box Price: $4.89 Quantity Sterile Gauze Pads 2” x 2” QuantityItem No: 10351 - 100ct Box Price: $6.49 Quantity Sterile Gauze Pads 3”X3” QuantityItem No: 10352 - 100ct Box Price: $7.50 Quantity Sterile Gauze Pads 4” x 4” QuantityItem No: 10353 - 100ct Box Price: $10.65 Quantity Multi-Trauma Dressing 10” x 30” QuantityItem No: 10469 Price: $2.99 Quantity Kinkel Sterile Gauze 4.5”x5yd QuantityItem No: 10341 Price: $1.79 Quantity Blood stopper Compress Dressing QuantityItem No: 10470 Price: $2.39 Quantity Tendersorb ABD Pad 5”x9” QuantityItem No: 10471 Price: $0.59 Quantity Nasal Mist 1.5oz QuantityItem No: 10432 Price: $3.50 Quantity 1/2oz Eye Drops QuantityItem No: 10281 Price: $3.47 Quantity 1oz Eyewash QuantityItem No: 10276 Price: $2.25 Quantity 4oz Eyewash QuantityItem No: 10277 Price: $3.28 Quantity Refresh Plus Eye Lube 30ct QuantityItem No: 10287 Price: $29.73 Quantity Eye Pads w/tape QuantityItem No: 10290 - Case Qty: 4ct/bx Price: $1.92 Quantity Eye cups 6ct QuantityItem No: 10270 Price: $2.67 Quantity Hand Sanitizer 4oz Bottle QuantityItem No: 10401 Price: $1.95 Quantity Hand Sanitizer 2oz Bottle QuantityItem No: 10403 Price: $1.09 Quantity Inhalant Ammonia 10ct QuantityItem No: 10405 Price: $2.80 Quantity First Aid Burn Cream 144ct QuantityItem No: 10217 Price: $16.65 Quantity 3-1 Antibiotic Ointment 144ct QuantityItem No: 10448 Price: $16.94 Quantity Alcohol 70% 16OZ Bottle QuantityItem No: 10500 Price: $4.25 Quantity Hydrogen Peroxide 16oz Btl QuantityItem No: 10514 Price: $1.85 Quantity Tape Porous Wht. Cloth 1” QuantityItem No: 10630 - Case Qty: 12ct/bx Price: $18.95 Quantity Antiseptic Wipes 100ct QuantityItem No: 10674 Price: $6.35 Quantity Alcohol Wipes 200ct QuantityItem No: 10676 Price: $3.95 Quantity MEDICATIONS:Aspirin 325 mg - 250ct QuantityItem No: 22202 Price: $12.45 Quantity Cetafen non-aspirin 325mg QuantityItem No: 22208 - 500ct/bx Price: $29.68 Quantity Cetafen non-aspirin Extra 500mg QuantityItem No: 22211 - Case Qty: 500ct/bx Price: $29.80 Quantity Nutralox Antacid QuantityItem No: 22216 - 250ct/bx Price: $9.95 Quantity Ibuprofen 200mg QuantityItem No: 22107 - 250ct/bx Price: $16.95 Quantity Cold & Cough Relief QuantityItem No: 22135 - 40 2/pk Price: $9.55 Quantity Diphen antihistamine 25mg QuantityItem No: 22000 - 200ct/bx Price: $17.95 Quantity Diamode antidiarrheal QuantityItem No: 22410 - 24ct/bx Price: $5.95 Quantity Alka Seltzer QuantityItem No: 22002 - 72ct/bx Price: $26.50 Quantity Electrolyte heat stress tablets QuantityItem No: 22117 - 250ct/bx Price: $21.80 Quantity Pain & Ache Relief 40 2pk ( Like Tylenol ) QuantityItem No: 22233 Price: $5.00 Quantity Sinus Decongest 250ct QuantityItem No: 22134 Price: $16.85 Quantity Sinus Pain Relief 250ct QuantityItem No: 22131 Price: $22.95 Quantity Pepto Bismol Tablets QuantityItem No: 22124 - 48ct/bx Price: $16.95 Quantity Cherry Cough Drops 125ct QuantityItem No: 22214 Price: $14.15 Quantity ALLSPORT HYDRATION STRAWBERRY WATERMELON POWDER MIX STICKS 10 CT (SIMILAR TO IV) QuantityItem No: 023-ALLSP-ELITE-STAW ( MEETS USFS STANDARDS ) Price: $7.15 Quantity ALLSPORT HYDRATION LEMON TWIST POWDER MIX STICKS 10 CT (SIMILAR TO IV) QuantityItem No: 023-ALLSP-ELITE ( MEETS USFS STANDARDS ) Price: $7.15 Quantity DripDrop Electrolyte Powder Sticks Berry Flavor - 100ct QuantityItem No: 023-61407 ( MEETS USFS STANDARDS ) Price: $183.00 Quantity DripDrop Electrolyte Powder Sticks Lemon Flavor - 100ct QuantityItem No: 023-61406 ( MEETS USFS STANDARDS ) Price: $183.00 Quantity DripDrop Electrolyte Powder Sticks Orange Flavor - 100ct QuantityItem No: 023-61410 ( MEETS USFS STANDARDS ) Price: $183.00 Quantity DripDrop Electrolyte Powder Sticks Watermelon Flavor - 100ct QuantityItem No: 023-61408 ( MEETS USFS STANDARDS ) Price: $183.00 Quantity DripDrop Electrolyte Powder Sticks Grape Flavor - 100ct QuantityItem No: 023-61431 ( MEETS USFS STANDARDS ) Price: $183.00 Quantity DripDrop Electrolyte Powder Sticks Lemon Lime Flavor - 100ct QuantityItem No: 023-61441 ( MEETS USFS STANDARDS ) Price: $183.00 Quantity MEDICAL SUPPLIES:Adult Aneroid BP Cuff QuantityItem No: 30001 Price: $34.95 Quantity Stethoscope Nurses Dual Head QuantityItem No: 30015 Price: $11.79 Quantity Paramedic All Purpose Shears 7 ½” QuantityItem No: 30060 Price: $4.50 Quantity CPR Barrier Shield QuantityItem No: 11002 Price: $11.50 Quantity 1895 N95 Respirator Mask QuantityItem No: 09-008 - 20ct/bx Price: $13.66 Quantity 3-ply Medical Face Mask QuantityItem No: 009-083 - 50ct/bx Price: $5.50 Quantity Infrared touchless thermometer QuantityItem No: 30-INFRARED Price: $49.75 Quantity Nasal Cannula Adult QuantityItem No: 30055 Price: $0.95 Quantity Splinter-Out 10ct QuantityItem No: 30074 Price: $2.75 Quantity 4 Mil Latex PF Gloves S-XL QuantityItem No: 03040 - 100ct/bx Price: $5.65 Quantity Penlight Disposable QuantityItem No: 30110 Price: $1.68 Quantity 4 mil Nitrile PF Gloves SM QuantityItem No: 03020 - 100CT Price: $3.95 Quantity 4 mil Nitrile PF Gloves MD 100 QuantityItem No: 03020 - 100CT Price: $3.95 Quantity 4 mil Nitrile PF Gloves LG QuantityItem No: 03020 - 100CT Price: $3.95 Quantity 4 mil Nitrile PF Gloves XL QuantityItem No: 03020 - 100CT Price: $3.95 Quantity 6 mil Black Nitrile Gloves PF S QuantityItem No: BB5000-SM 100ct/bx Price: $7.50 Quantity 6 mil Black Nitrile Gloves PF M QuantityItem No: BB5000-M 100ct/bx Price: $7.50 Quantity 6 mil Black Nitrile Gloves PF L QuantityItem No: BB5000-L 100ct/bx Price: $7.50 Quantity 6 mil Black Nitrile Gloves PF X QuantityItem No: BB5000-X 100ct/bx Price: $7.50 Quantity Name First Last Email PhoneBilling Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern 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BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of 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