Drug Test Order Form

CAL-TEST Drug Prevention Services

is committed to providing the highest quality and legally defensible services and practices available within today's marketplace.

CONTACT & DONOR INFORMATION (Please fill out all information)

Donor's Name:(*)

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Company Name:(*)

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Requesting Person:(*)

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Collection Site:(*)

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Collection Site Address:(*)

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SSN:(*)

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Phone:(*)

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Appointment Date:(*)

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Appointment Time(*)

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TEST DETAILS

Test Requested:
D.O.T. Urine (Title 49 CFR Part 40) - 60.00 USD "Look-a-like" (DOT Mirror) - 60.00 USD
NON DOT Urine Drug Test, with GC/MS & MRO 5 Panel (Tests for 5 drugs) - 50.00 USD 9 Panel (Tests for 9 drugs) - 60.00 USD 30 Panel (Tests for 30 drugs) - 125.00 USD
Breath Alcohol Screen, with EBT confirmation D.O.T. Breath Alcohol - 35.00 USD NON-D.O.T. Breath Alcohol - 35.00 USD
Instant Urine Drug Screen - 5 Panel, GC/MS & MRO extra* - 35.00 USD Collection ONLY, using Sender's Lab - 20.00 USD HAIR Follicle Test 5 Panel includes MRO. - 150.00 USD Lab Based Saliva - 125.00 USD

Reason For Test:
Pre-Employment, Pre-Placement or 30+ Days Leave Return Reasonable Suspicion Post Accident Random Return to Duty (Previous Policy Violation) Follow-Up Other Invalid Input

Test Deadline:*()**
Direct Observation Required (same sex).Invalid Input

Order Total: 0.00 USD

Confirmation Email: (*)