Please complete as much of the information requested in the form below to help us prepare a quote for your drug-free workplace program. If you prefer to have an initial discussion with our representatives about your organization’s needs, give us a call at 912.691.0282 – we’re happy to help! One of our representatives will respond to your e-mailed request within 24 hours of submittal to gather and clarify the information provided. Metroplex looks forward to serving your screening needs!

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Requestor information: (all fields with * are required)
*First Name:
*Last Name:
*Title:
*Company:
*Address:
*City:
*State:
*Zip Code:
*Phone:
*Fax:
*Email:
Industry:
Number of employees:
How did you learn of our services?:
Yes, my company is currently drug testing:
Testing method(s):	urine     hair    oral fluids    breath alcohol    rapid
Test panel:	5      9    other:
Number of DOT tests annually:
Number of non-DOT tests annually:
Number of locations:
Services requested (please check all of interest)
Alcohol data management	Alcohol testing
Blind Specimens	Employee education
Employment background checks	Hair testing
Laboratory	Model policy
MRO	On-site urine testing
Oral fluids testing	Physical examinations
Post-Accident	Random
Rapid On-site testing	SAP referral
Specimen collection	Supervisor training
Other: