| Reduced Fee Drug Screening
Voucher (General) |
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| Client Name: |
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Court Case # (JD, CM, CF) |
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| Client Phone: |
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(DHS, CW Only), KK#: |
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| Referral Name: |
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Phone: |
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| Email: |
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| Drug Screening Program Options:
(Check all that apply) |
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One
Time
Test: or
Random
Testing: (5-days
(M-Fri) a week, or
7-days (M-Sun) a week) |
| Random
Schedule will consist of ..
tests per month for
month(s) or
tests per week for
month(s) |
| Type of Testing: (Check all that
apply) |
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Urinalysis:
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(One Panel) |
Reduced Fees |
Drug Requested:
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(7 Panel, Same Day Results) |
Reduced Fees |
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(7 Panel, Results in 1-3 Days) |
Reduced Fees |
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(7 panel
test - alcohol, THC, cocaine, amphetamine, opiates, methamphetamine,
benzodiazepines, & barbiturates) |
Adulteration Testing:
(Check here, if you think the client is tampering or masking their
samples)
(Additional fees apply. Detects the use of masking agents, bleach,
and other methods clients try to use to cover up or hide their drug
use) |
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Hair Follicle:
(Results in 2-3 Days) |
Reduced Fees |
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| (Hair Follicle Testing can
detect regular drug use over a 90 day period, 5-panel test -
cocaine, amphetamines, opiates, thc, & pcp) |
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Saliva Test: (Results in 2-3 days) |
Reduced Fees |
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Alcohol Breathe
(Breathalyzer) Testing: |
Reduced Fees |
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EtG Extended Alcohol Urine Test: |
Reduced Fees |
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CAM- Continuous Alcohol Monitoring: |
Reduced Fees |
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(24/7 Alcohol and Curfew
Violation Ankle Monitoring Bracelet. Detects any and all alcohol use
24 hours a day) |
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GPS Monitoring: |
Reduced Fees |
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(24/7 GPS/location monitoring for any client that needs to have
their location monitored i.e. (sex offenders, VPO’s, domestic
violence cases, etc) |