Order Urine Drug Test Urine Test5 Panel NON-DOT Price: $65.99 Quantity: *5 Panel Rapid Results Price: $65.99 Quantity: 5 Panel DOT(FMCSA-FAA-FTA-PHMSA) Price: $69.99 Quantity: 5 panel DOT(USCG+Form719 P) Price: $69.99 Quantity: 5 panel Return to Duty(DOT-Observed) Price: $89.99 Quantity: 5 Panel + Exp Opiates Price: $79.99 Quantity: 10 Panel Price: $89.99 Quantity: *10 Panel Rapid Results(Not available in the State of New York) Price: $99.99 Quantity: 10 Panel + Exp Opiates Price: $109.99 Quantity: Nursing/Medical Drug Test Price: $139.99 Quantity: 12 Panel (Comprehensive) Price: $139.99 Quantity: Observed Test( In addition to test ordered ) Price: $20.00 Quantity: ETG Alcohol(80-hour lookback) Price: $99.99 Quantity: 5 Panel + ETG(80-hour lookback) Price: $139.99 Quantity: 5-Panel + Alcohol(8-hour lookback) Price: $99.99 Quantity: Total $0.00 Please provide the full name, e-mail address, phone number, social security number(for specimen identification tracking) and test type.*All information is confidential and secure. Reason for testPlease Select -Pre-EmploymentRandom SelectionReasonable SuspicionPost AccidentCourt OrderedOtherPerson(s) Taking Test*Example:John Smith | Jsmith@example.com | (501)423-5565 | 495-09-3452 | 5 panel urineUse the + button to add as many test registrations / Donor passes as needed.Full NameEmailPhone NumberSocial SecurityTest Type ( Example: 5 panel urine) Preferred Location*The preferred testing location listed below will be used to schedule the test you have selected. In the event the test you have selected is unavailable at that location an alternate testing center in the same zip code area will be selected for you.Test Results*Please provide the e-mail address to send the confidential test results.Confidential Email Address Phone NumberEmail AddressWhere donor pass/authorization form will be sent. Contact ( full name ) - If other than person taking testCompany Name ( if applicable )Company Phone Number* I Agree - Terms and Conditions Total $0.00 Credit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Expiration Date Security Code Cardholder Name Billing Zip Code*Payment Information Coastal Drug Testing provides secure and safe processing of your order using Authorize.net Secure Checkout. MemberYesNoPhoneThis field is for validation purposes and should be left unchanged.