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
Address
Billing Address
Ok to receive results, work status, etc?
Preferred contact method for results:
Ok to receive results, work status, etc?
Preferred contact method for results:
Work Comp Carrier Address
Company has:

Services Needed

Pre-Employment
Post-Accident
Post-accident drug screen preference:
Post-accident breath alcohol test preference:
Random
Reasonable Suspicion

Please list any other services needed.