Collection Site Enrollment

Pipeline Testing Consortium values the relationship we have with collection sites. We understand that the collection site is a vital and necessary step in the alcohol and drug collection process; therefore, we treat collection facilities with the professionalism they deserve. If you would like to be added to our collection site list, please fill out the collection site questionnaire.

If you are already on our collection site list and want to update your information or learn how to become a Preferred* vendor, please contact us.

*Please refer to the "Preferred Testing & Locations" definition.

(All fields are required.)

Collection Site Name:  
Contact Name:  
Are your collectors DOT qualified to conduct collections? (details)  
Drug Collection Only Fee:  
Breath Alcohol Fee:  
Do you conduct eCCF collection for CRL via FormFox?  

If yes, please provide your FormFox ID#: