Personal Drug Testing Consent Form

Personal Drug Testing Consent Form
Client Information:
Name:
Date of Birth:

MonthDayYear
Date
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number:
Email Address:
example@example.com
Consent to Test:
I, the undersigned, voluntarily provide my consent to Kerl Lab Services and its designated laboratory partners to conduct drug and/or alcohol testing. I understand that the procedure involves a collection of a sample (urine, blood, hair, or saliva) which will be tested to detect the presence of drugs or alcohol.
Purpose of Test:
The purpose of this test is for personal knowledge and use, and not for employment or legal reasons.
Type of Test:
Please specify the type of test you wish to conduct: Urine, Blood, Hair, Saliva
Drugs to be tested (if applicable):

Personal Drug Testing Consent Form
Please indicate the drugs to be tested: THC (Cannabis, Marijuana), Cocaine, Opiates, Amphetamines, Others (specify):
Confidentiality:
I understand that the results of the drug test will be treated as confidential. They will only be disclosed to me and any other parties I have authorized in writing.
Right to Withdraw Consent:
I understand that I have the right to withdraw my consent to the testing process at any time before the completion of the test.
Release of Liability:
I release Kerl Lab Services, its staff, and affiliated partners from any legal responsibility or liability for any consequences arising from the drug test or from the disclosure of the test results in accordance with this consent form.
Signature:
I certify that I have read and understood this consent form, and I agree to its terms.
Signature:
Date:

MonthDayYear
Date