Section Menu Recent News Owensboro Health Twin Lakes Medical Center Hosts Fitt Fiddle 5K and Family Fun Walk July 24, 2025 Hydration and Exercise Considerations in the Heat July 21, 2025 A Story of Gratitude: Bobby’s Wish for Owensboro July 21, 2025 Milestone Moment in Heart Care! July 15, 2025 Owensboro Health Twin Lakes Medical Center Achieves Pediatric Readiness Certification July 2, 2025 View More Employer Services New Company Form To initiate your account setup and receive your protocol instructions, please fill out the new company form below. Denotes required fields Company Name Number of Employees Address Address Address 2 City State? ZIP Code? Phone? Fax? Billing address is same as above. Billing Address Billing Address Address 2 City State? ZIP Code? Billing phone and fax are the same as above. Billing Phone? Billing Fax? Designated Employer Rep: First Name Last Name Phone? Fax? Email Ok to receive results, work status, etc? Yes No Preferred contact method for results: Email Fax Secondary Contact: First Name Last Name Phone? Fax? Email Ok to receive results, work status, etc? Yes No Preferred contact method for results: Email Fax Work Comp Carrier Adjuster/Contact Phone? Fax? Work Comp Carrier Address Address Address 2 City State? ZIP Code? Company has: DOT employees only Non-DOT employees only Both DOT and Non DOT employees Services Needed Pre-Employment Physical Drug Screen DOT Physical Please list what is included in your physical requirements (ex: audio, drug screen, PFT, BAT, EKG, etc.) Please list what drug screen panel, or if it is a collect (if it is a collect please list: lab, courier and any special instructions) Please list what is included in your physical requirements (ex: audio, drug screen, BAT, PFT, EKG, etc.) Post-Accident Drug Screen Breath Alcohol Test Post-accident drug screen preference: All new injuries If requested only Please list what drug screen panel, or if it is a collect (if it is a collect please list: lab, courier and any special instructions) Post-accident breath alcohol test preference: All new injuries If requested only Only within 8 hours of injury Special instructions/notes Random Drug Screen Breath Alcohol Test Please list what drug screen panel, or if it is a collect (if it is a collect please list: lab, courier and any special instructions) Reasonable Suspicion Drug Screen Breath Alcohol Test Please list what drug screen panel, or if it is a collect (if it is a collect please list: lab, courier and any special instructions) Other Services Please list any other services needed. Leave this field blank
