Scheduling

Please complete the form below to schedule a Drug/Alcohol Test outside our facility. Please note that you must submit one completed form for each test the employee needs. After completing the form, you will receive your ePassport(s) within 15 minutes. Thank you

* Indicates required field

1.1- Company Name *

1.2- Name - Requesting Company Official *

First

Last

1.3- Email - Requesting Company Official *

2.1- Employee Name *

First

Last

2.2- Employee SSN *

2.3- Employee DOB *

2.4- Employee Phone # *

2.5- Zip Code (Employee) *

3.1- Type of Test (Select One) *

3.2- Reason for Test (Select one) *

3.3- Additional Instructions *

Submit