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Drug Test Registration Form

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Legacy Laboratory Services - Toxicology: 800-950-5295

Date:
Applicant/Employee:
SS#:


Company: Division:
Phone: Contact Person:
Account #:

Instructions:

  1. Your company must have a current Legacy Toxicology account to use this form. Call 503-413-5295 or 800-950-5295 toll free.
  2. You may request a drug screen at any of the locations listed below without an appointment.
  3. Please bring this form with you at the time of your specimen collection.
  4. Avoid drinking excessive amounts of liquids 3 to 4 hours prior to specimen collection.
  5. You MUST present PHOTO ID at the time of specimen collection.

Drug/Alcohol Test Options
(please check appropriate box)

NON-DOT Options

DOT Options
(Federal Mandated Testing)

Pre-Employment (Post Offer) Follow up Pre Employment

Follow up

Post Accident Return to Duty Post Accident Return to Duty
Reasonable Cause Breath Alcohol Reasonable Cause Breath Alcohol
Random Fast-Trak Screen Random  

Drug Test Collection Site(s):

† Fast-Trak, One Hour Drug Screen available at these sites
‡Breath Alcohol testing available at these sites
*Saliva Alcohol Testing

Legacy Laboratory - Central: 1225 NE 2nd Ave, first floor, Portland, OR 97232 †‡*
Telephone: 503-413-5000  Fax: 503-413-5485
Open 24 hours from Monday 7:00 am thru Saturday 4:30 pm [Closed Sunday]

Legacy Toxicology - Twin Oaks: 1815 NW 169th Place, Bldg 6, Suite 6025, Beaverton, OR 97006 †‡*
Telephone: 503-533-2278  Fax: 503-533-8238
Hours: Monday-Friday 8:30 am - 5:00 pm, closed noon - 12:30 pm

Legacy Laboratory - St. Helens: Good Samaritan Medical Mall, 500 N. Columbia River Hwy, St. Helens, OR 97051†*
Telephone: 503-397-1801 Fax: 503-366-3484 
Hours: Monday-Friday 8:30 am - 5:00 pm

Legacy Toxicology - Tualatin: 7587 SW Mohawk St, Tualatin, OR 97062 †‡*
Telephone: 503-692-2700 Fax: 503-692-4546
Hours: Monday-Friday 8:30 am - 5:00 pm, closed noon - 12:30 pm

Legacy Toxicology - Vancouver West: 3305 Main St, Suite 111, Vancouver, WA 98663 †‡*
Telephone: 360-750-9765 Fax: 360-750-9770
Hours: Monday-Friday 8:30 am - 5:00 pm, closed noon - 12:30 pm

Last updated: May 17, 2010

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