| Reduced Fee Drug Screening
Voucher (Putman City Schools) |
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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: |
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Urinalysis: (One Panel) |
Reduced Fees ($15) |
Drug Requested: |
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(7 Panel, Results in 24-48 Hours) |
Reduced Fees ($25) |
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(7 panel
test - alcohol, THC, cocaine, amphetamine, opiates, methamphetamine,
benzodiazepines, & barbiturates) |
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Hair Follicle:
(Results in 2-3 Days) |
Reduced Fees ($80) |
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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 ($20) |
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(6-panel test - thc, cocaine,
amphetamine, opiates, methamphetamine, pcp) |
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Random
Testing: |
| Random Schedule will consist of
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tests per month for
month(s) |
| OR... |
tests per week for
month(s) |
| (Do you want the client to
test?): |
5-days
(M-Fri) a week, or
7-days
(M-Sun) a week. |
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Urinalysis: (One Panel) |
Reduced
Fees ($15) |
Drug Requested: |
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(7 Panel, Results in 24-48 Hours) |
Reduced Fees ($25/15) |
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(7 panel
test - alcohol, THC, cocaine, amphetamine, opiates, methamphetamine,
benzodiazepines, & barbiturates) |
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Hair Follicle:
(Results in 2-3 Days) |
Reduced Fees ($80) |
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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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ETG Alcohol Testing: |
Reduced Fees ($35) |
+ 7
Panel ($40) |
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Additional Drugs Requested: (Check here if you want additional drugs
tested). |
| Additional fees apply. Fees are dependent on # of
additional tests requested. |
| Drug Requested: Drug Requested:
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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. |