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*
) are mandatory.
Corporate Information
Corporate Name
*
Street Address
City
State
Zip Code
Phone
*
Fax
Email
*
Program Contact
*
Billing Contact
*
How many employees do you have?
*
Current Policy & Preferences
How would you like to receive results?
*
Email
Fax
How would you like to receive invoices?
*
Email
Postal Mail
Authorized to receive results:
*
Do you have a secure fax number for positive results?
*
Do you currently have a DFWP Policy in place?
*
Yes
No
Are you currently drug testing?
*
Yes
No
Disciplinary policy for positive result of an employee:
*
Immediate Termination
2nd Chance
Do you have a preference of laboratories to work with?
*
Is your company regulated by the Department of Transportation (DOT)?
*
Yes
No
Worker's Comp Information
Who is worker's comp insurance carrier?
Policy #:
Agency name:
Contact:
Phone:
Other Information
Are you interested in random drug testing?
*
Yes
No
Do you want to test all of your employees once the 60-day notice period expires?
*
Yes
No
Do you currently conduct background investigations on your new hires?
*
Yes
No
Do you currently have an employee assistance program in place?
*
Yes
No
How did you hear about NMS?
Contact NMS Management Services Today!
Benefits of NMS
Employee Assistance Program
Instant Testing
Policy Development
Random Testing
Related Resources Via Links
LabCorp of America Collection Site Locator
Quest Diagnostics Collection Site Locator
SAMHSA Workplace Programs
Office of National Drug Control Policy
DOT Drug & Alcohol Compliance
Department of Transportation