Drug Test Consent Form

Document Overview

This is a fillable drug test consent form. Click any blank field in the document below, type your information, and your entries will autosave in your browser. Use the toolbar at the top to print, save as PDF, or download a completed copy. Below the form, you'll find a guide to using this document, common mistakes to avoid, and answers to the questions we hear most often about drug test consent form.

I, _____________________________, understand that Name needs my authorization to conduct a drug test Description . I have been informed of and understand the testing procedure.

I agree to provide any specimens needed to conduct the drug test. I understand that if I refuse to undergo drug screening, Job termination / Expulsion from school / Other I may be subject to immediate termination . I understand too that if I consent to the test and the results are positive, the results will be reported to Requester Name and I may be Description for violation of Requester Name 's drug policy. This policy exempts the use of legally prescribed medications taken under the direction of a physician.

I have taken the following drugs or substances within the last 96 hours:

I hereby (   ) consent (   ) refuse to consent to undergo the drug test(s). I authorize any physician, laboratory, hospital, or medical professional retained by Requester Name to conduct this drug test and to provide the results to Requester Name . I release Requester Name , any person affiliated with Requester Name , and any institution or person conducting the drug test from liability. I give this consent pursuant to all state and federal privacy statutes and waive all rights to nondisclosure of this test record and results only to the extent of the disclosures authorized in this form.

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I have read and understood this consent form, and I sign without any coercion or duress by any individual or institution.

Signature:____________________________________ Date:_______________________________

Name:___________________________________________________________________________

Street Address:____________________________________________________________________

City, State, ZIP Code:_______________________________________________________________

Signature of parent/guardian:______________________________Date:_______________________

Parent/guardian name:_______________________________________________________________