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Nationwide Drug Screens

Your First Name *

Your Last Name *

Your best phone number *

Your BEST email address - (one that you check regularly) *

Last 4 digits of your social *

Your zip code (this will identify the closest collection site to you) *

Read Carefully! Based on the info you have provided, you will be emailed a Registration Form with the address and phone of all Lab Corp in a 50 mile radius. You MUST bring your Registration Form & photo ID with you in order to be tested. No Exceptions

You have read and agree to the above requirements *

Yes - I Agree

No - I Do Not Agree

Date your drug screen is needed by *

You grant Steven Sweeney & Associates LLC, permission to release your drug screen results to the person/organization you have indicated *

Yes - I Agree

No - I Do Not Agree

Only send results to Donor

Name of person you want notified of results

Email address of person to receive results

Messages or prescription you have

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