Urine Alcohol Testing Request

Your Full Name *

Best Number To Contact You *

Your Zip Code *

Your Email Address *

Last 4 Digits Of Your Social *

Message (If Any)

Read Carefully! You will be contacted to schedule your appointment by a SureScreen Labs. You MUST bring your Registration Number on or before the scheduled test date in order to be tested. You MUST also have a PICTURE ID with you.

You Have Read & Agree To The Above Requirements *