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Drug Testing Referral

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Offender Name
Referred By

Choose One

If You Chose Random Testing:

How Many Tests (per week/month)?

For How Many Months?
Type of Test:
(All test results are GC/MS confirmed by a
MRO and require 2-7 days for lab results)

(Marijuana, Cocaine, Phencyclidine (PCP),
Amphetamines (including Ecstasy),
Methamphetamines and Opiates)

(Any alchohol consumption for up to
3.5 to 5 days prior to test)

(Marijuana, Cocaine, Phencyclidine (PCP),
Amphetamines (including Ecstasy and
Methamphetamines), Barbiturates, Opiates,
Benzodiazepines, and current Alcohol
Levels in conjunction with the EtG test)

(Amphetamines (including Ecstasy),
Cocaine, Marijuana, Phencyclidine (PCP),
and Opiates)

Note: If actively enrolled in CAP classes,
all tests are discounted $5

Payment due at time of test
Cash or money order only

Specific Instructions
Requested By

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