Select Clinic Location Fossil Creek South Fort Worth

Full Name

SSN or Alternate ID #

Employer

DOB

DOT Drug Screen

Non-DOT Drug Screen (Lab Testing)

STAT Drug Screen

Breath Alcohol Testing

DOT Medical Examination

Physical Examinations

Ability Test / Worksteps

Instructions / Comments

Applicant to Pay Bill Employer

Print Name

Reset Signature

Phone

Email

Today's Date

Please advise that there are no children allowed in testing areas. Please make sure employee/candidate are able to comply.