Request A Test

    Note: All fields are REQUIRED

    Requesting Company Name

    Employee Name

    Employee ID#

    Testing Date Requested

    Testing Time Requested

    Reason For Testing
    Pre-EmploymentPost-AccidentReasonable SuspicionRandomFor Cause

    Type of Testing Needed
    DOT Drug ScreenDOT Alcohol Screen5-Panel Laboratory Drug Test10-Panel Laboratory Drug TestInstant Urine TestingInstant Saliva TestingOther

    Testing Location
    River Valley Drug Testing Office
    Onsite Testing

    Other Testing Site

    Company Contact Name

    Company Contact Email Address

    Company Contact Phone

    Additional Information?