(208) 353-0291

Business Name

Donor/s Name/s

Phone

Date for Proposed Testing

Will Send Calendar Invite

Select All That Apply.

5 Panel Instant Urine Drug Test (Immediate Result)

12 Panel Instant Urine Drug Test (Immediate Result)

Lab Urine Drug Test (Mailed Out, Bring Email/Paperwork)

Hair Follicle

Blood Draw

DNA

Pulmonary Function Test

Physical

Legal Documents

DOT

After Hours $25 (Normally Nights and Weekends)

Mobile Unit $25 (We come to you)

Type of Test

Pre-Employment

Random

Post-Accident

Reasonable Suspicion

Probation / Parole

Walk-In (Collection or Personal)

Anything You Want Us To Know?

ROI Acknowledge & Acceptance

Req# Auth# Barcode#

Thanks for submitting!

DrugShield Inc

"With The Shield You're Protected"

(208) 353-0291