Customer Enrollment form
Load Number: if applicable
Secure Fax #:
How would you like drug screen results and other information to be communicated to you? You may chose to receive information in more than one way if that is your preference.
What services will you usually order? You may choose more than one.
Urine drug screen - 5 panel
Urine drug screen - 5 panel + EtG
Urine drug screen - 10 panel
Urine drug screen - 10 panel + EtG
EtG Alcohol test
Urine drug screen - 8 panel + alc
Random Drug Screen Management
Would you like to establish a standard protocol that will be triggered upon your order for drug screening? Example--"Urine drug screen - 8 panel+ alc plus Random Drug Screen Management." Protocol will be utilized automatically unless otherwise specified by your order.
No. I will specify protocol with each order
Yes. Use the following protocol:
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