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:: Setup Account

Company Name:

Address:

Phone:

Fax:

Contact Name:

Phone:

Email Address:

Re-Enter
Email Address:

Work Comp Carrier:

Address:

Phone:

Drug Screen Required on All Injuries?

drugscreenrequired Yes No

Specify Services:

Drug Screening:

Drug Screening

DOT	Non-Dot 5, 9 Sub, Rapid
Collection Only

Alcohol Services:

Alcohol Screening

BAT

Saliva

Physicals:

Physicals

DOT (post offer/recertification)	Non-DOT
ancillary services (PFT, audiogram, TB skin test, Xray)

Clinic Hours:
8:00am - 5:00pm | Monday - Friday

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