Drug/Alcohol Testing

Reason For Testing *

Pre-employment

Random

Post Accident

Pre-Access

Reasonable Suspicion

Return to Duty

Follow-up (direct observation)

Other (specify in instructions)

INSTANT Drug Test (In Addition to Lab Based Testing/Additonal Costs Apply) *

Location For Testing *

On-Site Services (Appointment Only)

Company Contact Phone *

Donor Arrival *

This Form has been Completed By: *

Additional Instructions

Company Name *

Donor Name *

Company Contact Name *

Please Choose One *

DOT (Must Specify Authority)

NonDOT

TEST AUTHORIZATION FORM