Group Testing Request – pssscreeningsolutions.com

Select Drug Test

DOT 5-Panel Lab-Based Drug Test – $145.00
Non-DOT 5-Panel Lab-Based Drug Test – $125.00
Non-DOT 9-Panel No-THC Lab-Based Drug Test – $135.00
Non-DOT 10-Panel Lab-Based Drug Test – $145.00

Number of Employees / Individuals to Be Tested

Company / Organization Name

Company Contact Person

Company Contact Phone

Company Contact Email

First Choice – Preferred Appointment Date

First Choice – Preferred Time Window

Second Choice – Preferred Appointment Date

Second Choice – Preferred Time Window

Third Choice – Preferred Appointment Date

Third Choice – Preferred Time Window

Scheduling Flexibility

My appointment time is flexible
I need one of my selected time windows
Please contact me about other available times

Service Location Address

Address Line 1

Address Line 2

City

State

Zip Code

Service Location Confirmation

I confirm that the service location address provided above is the exact location where testing is to be performed. I understand that additional travel or service fees may apply if an incorrect service location is provided or if the service location changes after the appointment is confirmed.

Group Testing Details / Special Instructions

Appointment Request Acknowledgment

I understand that submitting this form does not confirm my appointment. PSS Screening Solutions will contact me to confirm availability and appointment details.

Late Cancellation / Unavailable at Arrival

I understand that a cancellation made less than 24 hours before a confirmed appointment will be charged a late cancellation fee of $50. If a representative of PSS Screening Solutions arrives at the confirmed location and the individual, employer, or group is unavailable to proceed with the scheduled service, an Unavailable at Arrival Fee will be charged at $75. Repeat occurrences will require prepayment for future services.

Employer Insufficient Specimen / Extended Collection Acknowledgment

I understand that insufficient-specimen situations will require additional collection time, follow-up procedures, or a return collection. For DOT collections, the required DOT shy bladder procedure will involve a waiting period of up to three hours, and a DOT shy bladder Procedure fee of $150 will be charged. For non-DOT collections, additional collection time or a return visit will be required, and a $75 Return Visit / Recollection Fee will be charged if a representative of PSS Screening Solutions must return for another collection. I acknowledge and accept responsibility for these charges on behalf of the employer or organization.

Mobile Service Fee

Total

$0.00

Group Testing Subtotal

Square

Card

Name on Card

Label: After-Hours / Emergency Service Fee

Holiday Service Fee

Fee Additional Preferred

Payment and Additional Fees Acknowledgment

I understand that all charges, including additional fees incurred before, during, or after service, must be paid in full. Except where disclosure is required by law, regulation, or an authorized testing process, PSS Screening Solutions may withhold reports, results, certificates, and other client deliverables until the account balance is paid in full.

On-Site Collection Requirements

To ensure an efficient and professional collection process, the employer must have the following arrangements in place before PSS Screening Solutions arrives:

Work Area: A clean, private area with a table approximately 4–6 feet long and at least two chairs for the collector and employee being tested.
Employee Seating and Scheduling: Employers must arrange for employees to report for testing in small groups, with no more than two employees waiting at a time. Adequate seating must be provided. Employees should not gather or form lines in hallways or outside the collection area.
Restroom Access: A suitable restroom that can be secured or monitored to prevent unauthorized entry during urine specimen collections.
Site Contact: A designated representative available to assist with parking, building access, restroom arrangements, and employee coordination.

PSS Screening Solutions will confirm site readiness before dispatch. Inadequate facilities or arrangements may delay or prevent collection services.

On-Site Collection Requirements Acknowledgement

I confirm that I have reviewed the On-Site Collection Requirements and agree to have the required workspace, restroom access, seating, and employee scheduling arrangements in place before PSS Screening Solutions arrives.