Order Scrubs - The Pain Management Group

For ALL NEW staff members, please include the information below to ensure proper tracking and payroll deduction, if desired.
- Select the Item #, color (navy or gray) & size—for both tops & bottoms
- THREE sets are provided by PMG. Any additional sets may be payroll deducted
- All scrub jackets are payroll deduction only
- Any new providers, please notate/reference
- Please designate the preferred name for the name tag

Your Name

First Last

Your Contact Email*

Employee Name*

First Last

Site Location

New Nametag Needed?*

Yes
No

Preferred Name for Name Tag

New Employee?*

Yes
No

Labcoat*

Click HERE for labcoat sizing chart

Women's Sizes*

Men's Sizes*

Scrub Top

Select an Item	Color	Size	Quanity

Scrub Pant

Select an Item	Color	Size	Quanity

Please Note: Scrub jackets and scrub sets in excess of the three provided by PMG are payroll deduction only. If you are ordering a scrub jacket and/or scrub sets in addition to those provided, please acknowledge the associated costs will be deducted from this employee’s pay.*

I acknowledge

p: 615.941.8501 f: 615.941.8502
billing: 615.239.2018

Our Promise to Patients.

p: 615.941.8501 f: 615.941.8502billing: 615.239.2018

p: 615.941.8501 f: 615.941.8502
billing: 615.239.2018