Drug / Alcohol Test Notification Form - KELMAR Safety, Inc.
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KELMAR Safety Inc.  

Drug / Alcohol Test Notification Form

Please use the following form to notify us when a donor has been sent to take a drug test at a remote location.

By completing this form below, KELMAR can proactively anticipate and track results to insure that you are notified of the results in a timely manner.

You may also contact the Drug Testing Department by calling 317-468-0730

Your Contact Information:
First Name:  Last Name: Company Name:
Company Location: Daytime Phone: Your Email Address:

Donor Information:
First Name: Last Name: SSN:
Date Sent:

 Clinic Information:
Clinic Name: Address:
State: Zipcode:
Phone: CCF Number

Choose the type of test(s) below that apply:
Choose the test(s) below that apply:

 Comments Section: