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Company Name
*
What is your company Name?
Person Authorizing
*
Who is authorizing these tests?
Phone Number
*
The phone number of the person authorizing these tests.
Email
*
Email for the person authorizing the test
Reason for Test
*
Pre-Employment
Random
Post-Accident
Reasonable Suspicion/Cause
Return To Duty
Follow-Up
Annual
Promotion
Other
Information and Guidelines
1. Donor must present legal photo identification. 2. No appointment necessary for drug testing services. 3. Employment and DOT Physicals require an appointment. Please call our office to schedule a date and time. (806) 359-7600 4. If this is a urine test, drinking fluids is recommended , but do not drink more than 24 ounces of fluids prior to the hour before your test. 5. Personnel at Prime Medical do not receive results for your testing. Results are sent directly to your company. 6. Prime Medical Testing's hours of operation are Mon- Fri 8:30 am to 5:30 pm.
Donor Name
*
Enter Employee or Applicant's Name
Date Donor Sent
*
Time Donor Sent
*
Hour
01
02
03
04
05
06
07
08
09
10
11
12
Minute
00
05
10
15
20
25
30
35
40
45
50
55
am/pm
AM
PM
Time to Complete
Enter how much time the Donor has to complete the test. 1 Hour, 24 Hours, 3 Days
Services Needed
*
DOT Drug Test
DOT Breath Alcohol Test
Non-DOT 10-Panel Lab-Based Testing
Non-DOT 5-Panel Lab Based Testing
Non-DOT Breath Alcohol Test
Hair Drug Test
Rapid Drug Screen (5-Panel Screened at Prime)
Rapid Drug Screen (10-Panel Screened at Prime)
DOT Physical (Call Prime for Appt Time)
Employment Physical (Call for Appt)
Collection Only (Donor provides COC Forms)
Additional Notes
Send me a copy
Home
About Us
Services
DOT Compliance
Drug Testing
DOT Physicals
DNA Testing
Background Checks
Medical Labwork
Life Insurance Exams
Exam Prep
Forms
Authorization Form
New Account Application
Employment Application
Links
Contact Us
Employment