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
Full Legal Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Driver’s License or ID Number
State Issued
Preferred Contact Method

Other
SERVICE REQUESTED
Service Requested

Other
Other Service Details
Reason for Testing
Employer Name
APPOINTMENT DETAILS
Preferred Appointment Date

MonthDayYear
Date
Preferred Time

Hour Minutes

AM/PM Option
Service Type
Collection Address ( if mobile)

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Special Instructions or Notes
IDENTIFICATION & CONSENT
Upload ID / Driver’s License

Cancelof
Electronic Signature
Consent
PAYMENT INFORMATION
My Products
prevnext( X )
Preferred Partner Court-Ordered Drug Testing
Court-Ordered Testing

$65.00



Standard Court-Ordered Drug Testing
Court-Ordered Testing

$95.00



Probation Compliance Testing
Court-Ordered Testing

$95.00



Rapid Non-DOT Drug Screening
Drug Testing

$85.00



DOT Drug Testing
Drug Testing

$145.00



Oral Fluid Drug Testing
Drug Testing

$125.00



Hair Follicle Drug Testing
Drug Testing

$225.00



Legal Hair Follicle Drug Testing
Drug Testing

$325.00



Alcohol / Breath Alcohol Testing
Alcohol Testing

$75.00



ETG / ETS Alcohol Testing
Alcohol Testing

$175.00



Observed Collection
Collection Services

$50.00



Office DNA Collection Only
Collection Services

$100.00



Legal Chain-of-Custody Collection
Collection Services

$150.00



Mobile DNA Collection (Within 15 Miles)
Collection Services

$250.00



Extended Mobile DNA Collection
Collection Services

$350.00



After-Hours Mobile DNA Collection
Collection Services

$450.00



Weekend / Holiday Mobile DNA Collection
Collection Services

$550.00



Peace-of-Mind Paternity DNA Testing
DNA Testing

$249.00



Motherless Paternity DNA Testing
DNA Testing

$249.00



Maternity DNA Testing
DNA Testing

$249.00



Twin Zygosity DNA Testing
DNA Testing

$225.00



DNA Profile Test
DNA Testing

$225.00



Y-Chromosome DNA Testing
DNA Testing

$325.00



Sibling DNA Testing
Relationship DNA Testing

$425.00



Aunt / Uncle DNA Testing
Relationship DNA Testing

$425.00



Grandparent DNA Testing
Relationship DNA Testing

$475.00



Grandparent DNA Testing With Mother Included
Relationship DNA Testing

$550.00



MTDNA Testing
Relationship DNA Testing

$650.00



Legal DNA Testing (Chain-of-Custody)
Legal & Immigration DNA

$495.00



Legal Sibling DNA Testing
Legal & Immigration DNA

$595.00



Legal Grandparent DNA Testing
Legal & Immigration DNA

$650.00



Immigration DNA Testing
Legal & Immigration DNA

$750.00



Apostille / Embassy Documentation Add-On
Legal & Immigration DNA

$150.00



Additional Participant Fee
Legal & Immigration DNA

$125.00



Prenatal Paternity DNA Testing
Prenatal DNA Testing

$1,995.00



Additional Alleged Father
Prenatal DNA Testing

$500.00



Express Prenatal Processing Upgrade
Prenatal DNA Testing

$350.00



DNA Comparison Testing
Forensic DNA Testing

$225.00



Semen Detection Testing
Forensic DNA Testing

$325.00



DNA Detection (Garment or Surface)
Forensic DNA Testing

$450.00



DNA Detection With Control Sample
Forensic DNA Testing

$650.00



Additional Forensic Item Testing
Forensic DNA Testing

$250.00



Oxycodone Add-On
Specialty Add-Ons

$45.00



Buprenorphine Add-On
Specialty Add-Ons

$45.00



Tramadol Add-On
Specialty Add-Ons

$45.00



Fentanyl Add-On
Specialty Add-Ons

$50.00



Synthetic Marijuana (K2) Add-On
Specialty Add-Ons

$75.00



Bath Salts Add-On
Specialty Add-Ons

$95.00



Nicotine / Cotinine Testing
Specialty Add-Ons

$65.00



Alcohol Urine Testing
Specialty Add-Ons

$85.00



Lab Confirmation Testing (Per Drug Class)
Positive Test Services

$95.00



MRO Review
Positive Test Services

$75.00



Bottle B Retest Request
Positive Test Services

$250.00



Standard Mobile Collection (Within 15 Miles)
Mobile Collection Services

$150.00



Extended Mobile Collection (15–30 Miles)
Mobile Collection Services

$225.00



Long Distance Mobile Collection (30–50 Miles)
Mobile Collection Services

$325.00



Standard Post-Accident Drug Testing
Post-Accident Services

$275.00



DOT Post-Accident Collection
Post-Accident Services

$350.00



After-Hours Emergency Mobile Response
Post-Accident Services

$450.00



Weekend / Holiday Emergency Response
Post-Accident Services

$550.00



After-Hours Appointment
After-Hours Fees

$125.00



Late Night / Overnight Appointment
After-Hours Fees

$225.00



Weekend Appointment Fee
After-Hours Fees

$175.00



Holiday Appointment Fee
After-Hours Fees

$225.00



Same-Day Scheduling Fee
After-Hours Fees

$75.00



Rapid Result Priority Service
After-Hours Fees

$50.00



Specimen Recollection Fee
After-Hours Fees

$75.00



Background Screening Intake
Employer Services

$85.00



I-9 Employment Verification
Employer Services

$45.00



E-Verify Processing
Employer Services

$35.00



Pre-Employment Screening Packages
Employer Services

$425.00



Total

$0.00
Payment Methods

Fastlane Checkout

Choose from one of the PayPal options to make your payment.

Contact Info

Payment Info
Should be Empty:

Client Intake Form

CLIENT INFORMATION

SERVICE REQUESTED

APPOINTMENT DETAILS

IDENTIFICATION & CONSENT

PAYMENT INFORMATION

My Products

Payment Methods