DOT and NON-DOT Drug Testing Form
Company Name
*
Employee Name
*
First Name
Last Name
Which test are you requesting?
*
DOT Urine Drug-Test Collection
Non-DOT Laboratory Drug-Test Collection
Non-DOT Rapid Drug Screening Inquiry
Is this urgent?
*
Yes
No
What is the reason for testing?
*
Pre-employment
Random Testing
Post Accident
Reasonable Suspicion
Return To Duty
Follow-Up Testing
Routine / Random
Where would you like the test to be performed other than the site's location?
*
Request an individual mobile appointment.
Request on-site testing at our office location.
Request a scheduled group collection event.
Preferred Method of Contact
*
Phone Call
Text Message
Email
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
I understand that submitting this form does not confirm an appointment. I understand that service availability, travel fees, and testing costs will be confirmed before service. I understand that applicable DOT testing procedures and laboratory requirements must be followed.
Please Select
Yes, I understand.
No, I do not understand.
Submit
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