PATIENT CHECK-IN Patient Full Name: * (As is appears on your license/ Govt ID) First Name Last Name Guardian (If the patient is a minor what is the guardian's Full name and present an ID) Phone #: * (###) ### #### Patient Date of birth * MM DD YYYY What service are you here for? * Drug Test (Urine) Drug Test (Hair) DNA Test Blood Draw Covid Testing Consultation Breath Alcohol test Urine Alcohol test Other If other service, what? Email For Results (If your test was pre-paid, we should already have this information) Please select the following * Self-pay (Pay upfront) Prepaid Online (present barcode authorization) My Employer Paid (present barcode authorization) Other Once this form is complete, you may head to the waiting area and a staff member will be with you momentarily and will call your name. * I Understand Thank you! A member from our team will be right with you!