Mobile Request Authorization

Mobile Request Authorization Form

Welcome to Accurate Diagnostics™ Web Order System. Please Complete the following Client Authorization Form. All Fields that are marked with an "*" are required fields. Please ensure that your email is spelled correctly to ensure delivery confirmation.

Company *

First Name *

Last Name *

Email Address *

How To Result Fax/Email *

ID Number

Reason For Test: *
Pre-Employment
Random
Post-Accident
Return To Duty
Resaonable Suspicion/Cause
Other

Must Test by:

Out of Town Collection
Yes

Street Address

City

State

Zip Code

Email Address

Donor Phone #

Comments

Urine-Same Day

Urine GCMS Lab

Oral Fluid

Hair/Nail

Alcohol

Payment *

Company Code

Serving Customers Throughout South Carolina

Greenville, SC
Columbia, SC
Anderson, SC
Spartanburg, SC

Seneca, SC
Greenwood, SC
Laurens, SC
Walhalla, SC

All locations are individually owned and operated.