Drug Screening Intake Form
This form must be completed in it's entirety. A dedicated team member will reach out within 24 hours with next steps.
Contact Name
*
Company Name
*
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Please choose which one do you want to be contacted by
Phone
Email
Does not matter
Other
Company Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please briefly explain what your company does
Select a date you're looking to get started.
*
-
Month
-
Day
Year
Date
Number of employees
If you're federally mandated, are you enrolled in a consortium or do you manage your own random testing?
*
Enrolled in a consortium
We manage our own
Would you require DOT drug testing or Non-DOT Drug Testing? (DOT=Department of Transportation)
*
DOT
Non-DOT
Does your company required mandatory random drug testing?
*
Yes
No
Would you prefer your drug testing take place in your office or at Kwik Screening?
*
In-office
Kwik Screening
Approximately, how many drug test do you expect to run on a monthly basis?
Please select the services you want us to provide
Consortium
Clearinghouse (Random)
Clearinghouse (Annual)
Pre-Employment Drug Test
Post-Accident Drug Testing
SAP Follow Up
Background Screenings
Other
Please give details about to service(s) you want from us
Please verify that you are human
*
Submit
Should be Empty: