10 Panel Urine

$75.00

Substances Tested	Amphetamine, Barbiturates, Benzodiazepine, Cocaine, Marijuana, Methadone, Morphine, Opiates, Phencyclidine (PCP), Propoxyphene

AMP-Amphetamines , COC-Cocaine, OPI-Opiates , PCP-Phencyclidine, THC-Marijuana, BZO-Benzodiazepines, BAR-Barbiturates, MTD-Methadone, PPX-Propoxyphene, Meth – Methaqalone.

Hidden

Test Ordered

Hidden

Test Name(Required)

Donor Information

Select DOT Agency(Required)

CDL number(Required)

(For specimen tracking purposes)

State of Issuance(Required)

Donor Name(Required)

First Last

Phone(Required)

Email(Required)

Date of Birth(Required)

Last 6 of SSN(Required)

(For specimen tracking purposes)

Reason for Test(Required)

Does this test need to be directly observed?

Yes

This means that a same-sex observer goes into the bathroom with the donor for a urine collection. It is a manual process to locate a site with an available observer which may cause a delay in receiving your donor pass.

Choose One(Required)

Male Observer

Female Observer

Return to Duty and Follow Up Drug Tests are under observation as per DOT rules.

Address(Required)

Will be used to locate the closest testing location.

Street Address Address Line 2 City State ZIP Code

Other Reason for Test

Hair Collection
Hair tests are typically cut from the scalp. In cases where enough head hair is not available, body hair (arms, underarms, chest, leg) can often be used. Not all collection sites will collect body hair.

Can Donor Provide Head Hair?(Required)

Yes

Results Delivery & Test Requisition

How should we send the results?(Required)

Email address to send results(Required)

Fax number to send results(Required)

Who should we attention the fax to?(Required)

Please send the Test Requisition Form to:(Required)

Person ordering the test

Donor, with a copy to person ordering the test

Direct Observation Fee

Price:

Total

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