Client Intake Form
  • Client Intake Form

    Professional intake form for compliance and testing services. Please complete the requested information so scheduling, documentation, and service coordination can be confirmed.
  • CLIENT INFORMATION

  • Format: (000) 000-0000.
  • Preferred Contact Method*
  • SERVICE REQUESTED

  • Service Requested*
  • APPOINTMENT DETAILS

  • Preferred Appointment Date*
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  • Service Type*
  • IDENTIFICATION & CONSENT

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  • PAYMENT INFORMATION

  • My Products

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                                                                                                                                                  Preferred Partner Court-Ordered Drug Testing

                                                                                                                                                  Court-Ordered Testing

                                                                                                                                                  $65.00$65.00
                                                                                                                                                    
                                                                                                                                                  Standard Court-Ordered Drug Testing

                                                                                                                                                  Court-Ordered Testing

                                                                                                                                                  $95.00$95.00
                                                                                                                                                    
                                                                                                                                                  Probation Compliance Testing

                                                                                                                                                  Court-Ordered Testing

                                                                                                                                                  $95.00$95.00
                                                                                                                                                    
                                                                                                                                                  Rapid Non-DOT Drug Screening

                                                                                                                                                  Drug Testing

                                                                                                                                                  $85.00$85.00
                                                                                                                                                    
                                                                                                                                                  DOT Drug Testing

                                                                                                                                                  Drug Testing

                                                                                                                                                  $145.00$145.00
                                                                                                                                                    
                                                                                                                                                  Oral Fluid Drug Testing

                                                                                                                                                  Drug Testing

                                                                                                                                                  $125.00$125.00
                                                                                                                                                    
                                                                                                                                                  Hair Follicle Drug Testing

                                                                                                                                                  Drug Testing

                                                                                                                                                  $225.00$225.00
                                                                                                                                                    
                                                                                                                                                  Legal Hair Follicle Drug Testing

                                                                                                                                                  Drug Testing

                                                                                                                                                  $325.00$325.00
                                                                                                                                                    
                                                                                                                                                  Alcohol / Breath Alcohol Testing

                                                                                                                                                  Alcohol Testing

                                                                                                                                                  $75.00$75.00
                                                                                                                                                    
                                                                                                                                                  ETG / ETS Alcohol Testing

                                                                                                                                                  Alcohol Testing

                                                                                                                                                  $175.00$175.00
                                                                                                                                                    
                                                                                                                                                  Observed Collection

                                                                                                                                                  Collection Services

                                                                                                                                                  $50.00$50.00
                                                                                                                                                    
                                                                                                                                                  Office DNA Collection Only

                                                                                                                                                  Collection Services

                                                                                                                                                  $100.00$100.00
                                                                                                                                                    
                                                                                                                                                  Legal Chain-of-Custody Collection

                                                                                                                                                  Collection Services

                                                                                                                                                  $150.00$150.00
                                                                                                                                                    
                                                                                                                                                  Mobile DNA Collection (Within 15 Miles)

                                                                                                                                                  Collection Services

                                                                                                                                                  $250.00$250.00
                                                                                                                                                    
                                                                                                                                                  Extended Mobile DNA Collection

                                                                                                                                                  Collection Services

                                                                                                                                                  $350.00$350.00
                                                                                                                                                    
                                                                                                                                                  After-Hours Mobile DNA Collection

                                                                                                                                                  Collection Services

                                                                                                                                                  $450.00$450.00
                                                                                                                                                    
                                                                                                                                                  Weekend / Holiday Mobile DNA Collection

                                                                                                                                                  Collection Services

                                                                                                                                                  $550.00$550.00
                                                                                                                                                    
                                                                                                                                                  Peace-of-Mind Paternity DNA Testing

                                                                                                                                                  DNA Testing

                                                                                                                                                  $249.00$249.00
                                                                                                                                                    
                                                                                                                                                  Motherless Paternity DNA Testing

                                                                                                                                                  DNA Testing

                                                                                                                                                  $249.00$249.00
                                                                                                                                                    
                                                                                                                                                  Maternity DNA Testing

                                                                                                                                                  DNA Testing

                                                                                                                                                  $249.00$249.00
                                                                                                                                                    
                                                                                                                                                  Twin Zygosity DNA Testing

                                                                                                                                                  DNA Testing

                                                                                                                                                  $225.00$225.00
                                                                                                                                                    
                                                                                                                                                  DNA Profile Test

                                                                                                                                                  DNA Testing

                                                                                                                                                  $225.00$225.00
                                                                                                                                                    
                                                                                                                                                  Y-Chromosome DNA Testing

                                                                                                                                                  DNA Testing

                                                                                                                                                  $325.00$325.00
                                                                                                                                                    
                                                                                                                                                  Sibling DNA Testing

                                                                                                                                                  Relationship DNA Testing

                                                                                                                                                  $425.00$425.00
                                                                                                                                                    
                                                                                                                                                  Aunt / Uncle DNA Testing

                                                                                                                                                  Relationship DNA Testing

                                                                                                                                                  $425.00$425.00
                                                                                                                                                    
                                                                                                                                                  Grandparent DNA Testing

                                                                                                                                                  Relationship DNA Testing

                                                                                                                                                  $475.00$475.00
                                                                                                                                                    
                                                                                                                                                  Grandparent DNA Testing With Mother Included

                                                                                                                                                  Relationship DNA Testing

                                                                                                                                                  $550.00$550.00
                                                                                                                                                    
                                                                                                                                                  MTDNA Testing

                                                                                                                                                  Relationship DNA Testing

                                                                                                                                                  $650.00$650.00
                                                                                                                                                    
                                                                                                                                                  Legal DNA Testing (Chain-of-Custody)

                                                                                                                                                  Legal & Immigration DNA

                                                                                                                                                  $495.00$495.00
                                                                                                                                                    
                                                                                                                                                  Legal Sibling DNA Testing

                                                                                                                                                  Legal & Immigration DNA

                                                                                                                                                  $595.00$595.00
                                                                                                                                                    
                                                                                                                                                  Legal Grandparent DNA Testing

                                                                                                                                                  Legal & Immigration DNA

                                                                                                                                                  $650.00$650.00
                                                                                                                                                    
                                                                                                                                                  Immigration DNA Testing

                                                                                                                                                  Legal & Immigration DNA

                                                                                                                                                  $750.00$750.00
                                                                                                                                                    
                                                                                                                                                  Apostille / Embassy Documentation Add-On

                                                                                                                                                  Legal & Immigration DNA

                                                                                                                                                  $150.00$150.00
                                                                                                                                                    
                                                                                                                                                  Additional Participant Fee

                                                                                                                                                  Legal & Immigration DNA

                                                                                                                                                  $125.00$125.00
                                                                                                                                                    
                                                                                                                                                  Prenatal Paternity DNA Testing

                                                                                                                                                  Prenatal DNA Testing

                                                                                                                                                  $1,995.00$1,995.00
                                                                                                                                                    
                                                                                                                                                  Additional Alleged Father

                                                                                                                                                  Prenatal DNA Testing

                                                                                                                                                  $500.00$500.00
                                                                                                                                                    
                                                                                                                                                  Express Prenatal Processing Upgrade

                                                                                                                                                  Prenatal DNA Testing

                                                                                                                                                  $350.00$350.00
                                                                                                                                                    
                                                                                                                                                  DNA Comparison Testing

                                                                                                                                                  Forensic DNA Testing

                                                                                                                                                  $225.00$225.00
                                                                                                                                                    
                                                                                                                                                  Semen Detection Testing

                                                                                                                                                  Forensic DNA Testing

                                                                                                                                                  $325.00$325.00
                                                                                                                                                    
                                                                                                                                                  DNA Detection (Garment or Surface)

                                                                                                                                                  Forensic DNA Testing

                                                                                                                                                  $450.00$450.00
                                                                                                                                                    
                                                                                                                                                  DNA Detection With Control Sample

                                                                                                                                                  Forensic DNA Testing

                                                                                                                                                  $650.00$650.00
                                                                                                                                                    
                                                                                                                                                  Additional Forensic Item Testing

                                                                                                                                                  Forensic DNA Testing

                                                                                                                                                  $250.00$250.00
                                                                                                                                                    
                                                                                                                                                  Oxycodone Add-On

                                                                                                                                                  Specialty Add-Ons

                                                                                                                                                  $45.00$45.00
                                                                                                                                                    
                                                                                                                                                  Buprenorphine Add-On

                                                                                                                                                  Specialty Add-Ons

                                                                                                                                                  $45.00$45.00
                                                                                                                                                    
                                                                                                                                                  Tramadol Add-On

                                                                                                                                                  Specialty Add-Ons

                                                                                                                                                  $45.00$45.00
                                                                                                                                                    
                                                                                                                                                  Fentanyl Add-On

                                                                                                                                                  Specialty Add-Ons

                                                                                                                                                  $50.00$50.00
                                                                                                                                                    
                                                                                                                                                  Synthetic Marijuana (K2) Add-On

                                                                                                                                                  Specialty Add-Ons

                                                                                                                                                  $75.00$75.00
                                                                                                                                                    
                                                                                                                                                  Bath Salts Add-On

                                                                                                                                                  Specialty Add-Ons

                                                                                                                                                  $95.00$95.00
                                                                                                                                                    
                                                                                                                                                  Nicotine / Cotinine Testing

                                                                                                                                                  Specialty Add-Ons

                                                                                                                                                  $65.00$65.00
                                                                                                                                                    
                                                                                                                                                  Alcohol Urine Testing

                                                                                                                                                  Specialty Add-Ons

                                                                                                                                                  $85.00$85.00
                                                                                                                                                    
                                                                                                                                                  Lab Confirmation Testing (Per Drug Class)

                                                                                                                                                  Positive Test Services

                                                                                                                                                  $95.00$95.00
                                                                                                                                                    
                                                                                                                                                  MRO Review

                                                                                                                                                  Positive Test Services

                                                                                                                                                  $75.00$75.00
                                                                                                                                                    
                                                                                                                                                  Bottle B Retest Request

                                                                                                                                                  Positive Test Services

                                                                                                                                                  $250.00$250.00
                                                                                                                                                    
                                                                                                                                                  Standard Mobile Collection (Within 15 Miles)

                                                                                                                                                  Mobile Collection Services

                                                                                                                                                  $150.00$150.00
                                                                                                                                                    
                                                                                                                                                  Extended Mobile Collection (15–30 Miles)

                                                                                                                                                  Mobile Collection Services

                                                                                                                                                  $225.00$225.00
                                                                                                                                                    
                                                                                                                                                  Long Distance Mobile Collection (30–50 Miles)

                                                                                                                                                  Mobile Collection Services

                                                                                                                                                  $325.00$325.00
                                                                                                                                                    
                                                                                                                                                  Standard Post-Accident Drug Testing

                                                                                                                                                  Post-Accident Services

                                                                                                                                                  $275.00$275.00
                                                                                                                                                    
                                                                                                                                                  DOT Post-Accident Collection

                                                                                                                                                  Post-Accident Services

                                                                                                                                                  $350.00$350.00
                                                                                                                                                    
                                                                                                                                                  After-Hours Emergency Mobile Response

                                                                                                                                                  Post-Accident Services

                                                                                                                                                  $450.00$450.00
                                                                                                                                                    
                                                                                                                                                  Weekend / Holiday Emergency Response

                                                                                                                                                  Post-Accident Services

                                                                                                                                                  $550.00$550.00
                                                                                                                                                    
                                                                                                                                                  After-Hours Appointment

                                                                                                                                                  After-Hours Fees

                                                                                                                                                  $125.00$125.00
                                                                                                                                                    
                                                                                                                                                  Late Night / Overnight Appointment

                                                                                                                                                  After-Hours Fees

                                                                                                                                                  $225.00$225.00
                                                                                                                                                    
                                                                                                                                                  Weekend Appointment Fee

                                                                                                                                                  After-Hours Fees

                                                                                                                                                  $175.00$175.00
                                                                                                                                                    
                                                                                                                                                  Holiday Appointment Fee

                                                                                                                                                  After-Hours Fees

                                                                                                                                                  $225.00$225.00
                                                                                                                                                    
                                                                                                                                                  Same-Day Scheduling Fee

                                                                                                                                                  After-Hours Fees

                                                                                                                                                  $75.00$75.00
                                                                                                                                                    
                                                                                                                                                  Rapid Result Priority Service

                                                                                                                                                  After-Hours Fees

                                                                                                                                                  $50.00$50.00
                                                                                                                                                    
                                                                                                                                                  Specimen Recollection Fee

                                                                                                                                                  After-Hours Fees

                                                                                                                                                  $75.00$75.00
                                                                                                                                                    
                                                                                                                                                  Background Screening Intake

                                                                                                                                                  Employer Services

                                                                                                                                                  $85.00$85.00
                                                                                                                                                    
                                                                                                                                                  I-9 Employment Verification

                                                                                                                                                  Employer Services

                                                                                                                                                  $45.00$45.00
                                                                                                                                                    
                                                                                                                                                  E-Verify Processing

                                                                                                                                                  Employer Services

                                                                                                                                                  $35.00$35.00
                                                                                                                                                    
                                                                                                                                                  Pre-Employment Screening Packages

                                                                                                                                                  Employer Services

                                                                                                                                                  $425.00$425.00
                                                                                                                                                    
                                                                                                                                                  Total
                                                                                                                                                  $0.00$0.00
                                                                                                                                                • Payment Methods

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