Athlete Drug Screening Form
Please complete this form to provide all required information for the athlete drug screening process.
Athlete Full Name
*
First Name
Last Name
Date of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Contact Email Address
*
example@example.com
Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Sport or Discipline
*
Please Select
Track and Field
Swimming
Cycling
Weightlifting
Football/Soccer
Basketball
Tennis
Other
Team/Organization Name
*
Screening Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Screening Location
*
Type of Drug Test
*
Urine Test
Blood Test
Saliva Test
Hair Follicle Test
Other
Reason for Test
*
Routine Screening
Random Selection
Competition Requirement
Suspicion of Use
Other
Test Results (if available)
Name of Test Administrator
*
Signature of Athlete (or Parent/Guardian if under 18)
*
Submit Screening Form
Submit Screening Form
Should be Empty: