FORENSIC TOXICOLOGY LAB
URINE DRUG SCREEN REQUEST FORM
This request form must be presented and filled out for all urine drug screen
requests which will not be billed by DeKalb Medical Center. Cash payment
(exact amount required) must be made at the time of collection. Please be
prepared to show a photo ID. Fill in the name of the person to be tested
below.
Company Name: DeKalb Medical Center
Pharmacy Department
Name of Student: ______________________________
Test Requested: FDS -10
Payment amount: $30 due at the time of collection
Mail results to student: Please fill in address below
____________________________________________
____________________________________________
Also Fax Results to: Scott McAuley, RPh, Pharmacy
Director, DMC 404-501-1431
------------------------------------------------------------------------------------------DeKalb Medical Center collection location:
Outpatient Lab, 2665 N. Decatur Rd., Suite 250, Decatur, GA 30033
Located in the Physician office building across the street from the DeKalb
Medical Center hospital parking deck. Take the elevator to the second floor,
Suite 250. Open Mon-Fri 8AM-5PM