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?