Schedule Drug & Alcohol Tests - Bulk

Schedule Drug & Alcohol Tests - Bulk

Schedule Drug & Alcohol Tests using this form that consists of a list of medical tests available through Mud Creek Medics alongside pricing. Please submit to us so we can contact you to confirm your requested dates and times.

1. Registrant Contact Information

Registrant Name
Registrant Name
First
Last

2. Test Date/Time Slot(s) Requested

Please state the day that you prefer to start the testing for the patients listed below. We are open Mon-Fri. Depending on how many patients you list and how many tests are required for each, this may span several days.
Time Requested to Begin
Please state the time you wish to start the testing for the patients listed below. Testing takes place in 1/2 intervals from 9:00 Am to 5:00 PM. Depending on how many patients you list and how many tests are required for each, this may span several days.

3. Patient List - Complete the Following for Each Person

Please provide the name of patient and test(s) required for him/her below. If more than 1 person is getting tested, use the pink "Add" button at bottom to add more people until you are finished listing each alongside the test(s) they require.
Name
Name
First
Last
Non DOT/DOT Urine Lab
POCT Urine Screen (Instant)
Oral Fluid Tests
Hair Sample Lab Test
Other Tests
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