Urine & Saliva Drug Test Sign-up – Medical Office

Getting Started

To inquire or sign-up for physician services, there three easy options:

Clinic Name (Client)*Number of LocationsOffice Contact Name

Office Contact Phone NumberOffice Contact EmailAddress*

FaxBilling Contact Name

Billing Type (check all that apply) Client Patient/Insurance

Report Delivery Method(s): (Check all that apply) Fax Email Online Result Portal (LabNexus)

Standard Work Days Monday Tuesday Wednesday Thursday Friday

Standard Opening Time

Standard Closing Time

How many times a week do you drug test the patient?Anticipated Start Date

Physician Name (1)

Online Result Portal Access Yes No

Physician Name (2)

Online Result Portal Access Yes No

Physician Name (3)

Online Result Portal Access Yes No

Notes