DOT and Non-DOT Drug Test
Request Form

I certify that all information provided above is true and correct to the best of my knowledge. I authorize my information to be disclosed to my employer/company, laboratory and/or the physical service site as needed.*

I understand that the laboratory processing my specimen may contact me for additional information needed to complete testing, clarify required details, or communicate issues related to my specimen or test order.

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I understand that test site may ask for SSN to process drug test. Clients have the choice to call Lab On Call to share SSN to process appointment request. *

I understand that the laboratory’s Medical Review Officer (MRO) may order additional testing, including confirmation testing, when required to complete the laboratory process. I acknowledge that any such additional testing may be billed to me or to my employer, depending on the employer’s policy. The MRO’s role is limited to laboratory review and administrative test authorization, not diagnosis or treatment.*