Off-Site Drug Testing

OFF-SITE DRUG TESTING - PRELIMINARY ENROLLMENT FORM

1) Company Information:

Company Name:
Subscriber Code (if applicable):
Your Name:
Position:
Address:
Phone:
Fax:
Email:
Today's Date:

Tax Exempt? Yes No

Do you require a Medical Review Officer (MRO)? Yes No
If Yes: Do you want MRO services on all tests Yes or only Positives Yes

Do employees fall under the Department of Transportation (DOT)?
Yes No

2) Please enter desired lab location zip codes:

After clicking Submit Order, a customer service representative will contact you with a quote for off-site drug testing services based on the zip codes provided.