Drug Testing Request Form

Drug Testing Request Form
Please fill out this form to request a drug test. All information provided will be kept confidential.
Requester's Name
First NameLast Name
Requester's Position
Requester's Email
example@example.com
Requester's Phone Number
Please enter a valid phone number.
Employee's Name
First NameLast Name
Employee's Position
Phone Number
Please enter a valid phone number.
Reason for Test
Pre-EmploymentPost-AccidentRandomReasonable SuspicionFollow UpReturn to DutyOther
Type of Drug Test
Urine TestHair Follicle TestSaliva TestBlood Test
Consent
Should be Empty: