Alcohol and Drug Testing Request Form - Solicitors

PLEASE COMPLETE ALL RELEVANT SECTIONS
Solicitor Full Name Title First Last Suffix
Solicitor Address
Street Address

Address Line 2

City

County / State / Province / Region

Post / Zip Code

Country
Solicitor Email
Solicitor Telephone
PLEASE INDICATE WHICH PRIORITY OF TEST YOU REQUIRE: (Please tick) STANDARD TEST - results in five (5) working days EXPRESS TEST - results in three (3) working days (additional fee of £100.00 plus VAT applies) 48 HOUR TEST - results in two (2) working days (additional fee of £250.00 plus VAT applies)
PLEASE STATE THE COURT DATE FOR THIS CASE (if any) / DD / MM YYYY
PLEASE NOTE: Sampling and subsequent testing will take approximately two (2) weeks.
FOR NEW CLIENTS ONLY: HOW DID YOU LEARN OF OUR SERVICES?
SAMPLE DONOR DETAILS
Donor Name Title First Last Suffix
Donor Address
Street Address

Address Line 2

City

County / State / Province / Region

Post / Zip Code

Country
Donor Date of Birth / DD / MM YYYY
Donor Telephone
Alcohol Testing
Period of Analysis e.g. 3 months

(Please contact customer services if you have any queries)
Number of Segments e.g. 3 segments

(Please contact customer services if you have any queries)
Hair Sample Collection Service: £95.00 plus VAT for the 1st sample and £65.00 plus VAT for each additional sample collected at the same collection appointment.
Mouth Swab / Blood Sample Collection Service: £55.00 plus VAT for the 1st sample and £25.00 plus VAT for each additional sample collected at the same appointment.
Analysis Required (please tick as appropriate) Liver Function Test (LFT) Hair Alcohol Analysis (EtG) CDT (Blood Test):
Drugs (Analytes) to be Tested (please tick as appropriate) Amphetamines* Cannabis Opiates Methamphetamines* Cocaine Zolpidem Benzodiazepines Methadone Ecstasy (MDMA)
* For Amphetamines and Methamphetamines, if one is requested, then we will test BOTH and charge for two tests.
Statement of Witness report (please tick as appropriate) Yes No
Please Note: There is an additional fee of £100.00 plus VAT for this service.
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Alcohol and Drug Testing Request Form - Solicitors

Alcohol and Drug Testing Request Form - Solicitors

PLEASE COMPLETE ALL RELEVANT SECTIONS

SAMPLE DONOR DETAILS

Alcohol Testing

Hair Sample Collection Service: £95.00 plus VAT for the 1st sample and £65.00 plus VAT for each additional sample collected at the same collection appointment.

Mouth Swab / Blood Sample Collection Service: £55.00 plus VAT for the 1st sample and £25.00 plus VAT for each additional sample collected at the same appointment.