Drug Test Authorization Form | Foxx Laboratories & Screening

Section 1 — Employee / Donor to complete

Your information

First name

Last name

Company you are coming from

Phone

Date of birth

Type of test

Panel requested

Preferred collection location (or mobile address)

Notes / prescribed medications

Section 2 — Signature

Sign with your finger

Sign here with your finger or mouse

Your signature authorizes specimen collection and testing.

I authorize Foxx Laboratories & Screening to collect a specimen and release results to the requesting company. The information I provided is accurate.

Section 3 — Laboratory use only

Drugs screened — 5-Panel

Employees cannot complete this section. Analytes are set by the panel selected above and confirmed by our certified laboratory staff.

Sent over an encrypted, HIPAA-conscious channel. Call before making an appointment — no walk-ins.

Drug test authorizationform.

Your information

Sign with your finger

Drugs screened — 5-Panel