New Customer or Update Form for Artesia Drug & Alcohol Screening Only

New Customer Account or Account Update

DOT u/a
non-DOT u/a
Breath Alcohol (EBT)
Hair
Rapid Test u/a
non-DOT SALIVA
Yes
No
Mailed:
Faxed
eMailed
Other
Name:
SS#:
Employee ID#:
Reason for Test:
Specimen ID#:
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