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Request Urine Drug / Alcohol Screening Services

Our alliances offer a full range of MRO services. You have the option of Directly Communicating and/or Requesting MRO services 24 Hours a Day 7 Days a Week! with a Licensed Health Care Provider. We provide electronic requisition tools and/or downloadable forms for confidential compliant direct interface with the MRO.
Available Drug & Alcohol Testing - SAMSHA/NIDA Certified Analysis, DATIA Accredited, SAMI Certified, On Site MRO Services

Authorization For "Medical Screening" Services:
Authorized By:
Employee Applicant:
Company Name:
Company Address:
 * required
 * required
 * required
 * required
Email address:
 * required
Telephone No:
 * required
Reason For Screening -  Please Note Single Selection Clicks or Multible Selections Are Allowed On This Form By Holding Down the "CTRL" Key and Clicking On Each Request:
   
Choose Screen & Test Type:
Corporate Bill
Self Pay
Yes Observation Required
No Observation Required
Note: DOT post accident testing requires breath alcohol.
Note: Observed specimen collections require supporting documentation and can only be ordered under specific conditions.
Note: (Screening Requires Photo Identification)
Comments:
 

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