Theme with DTC’s real preset tokens

Theme with DTC’s real preset tokens — simulated theme wrapper

Join our collection site network…

Tell us about your coverage area, qualifications, technology, service fees, and after-hours availability.

Approved sites receive dispatch requests for DOT and non-DOT collections in their coverage area. The rates you enter in Section 7 become your contracted rates on file.

~10 minute application
Mobile & fixed-site collectors
Business-hours & after-hours rates

Have these ready

Legal business name, EIN, and site address
Coverage ZIPs, counties, or cities
UDS collection-only and BAT pricing
Scheduled and immediate mobile rates
W-9 and insurance limits, on request

Your progress

0 of 0

Site & contact
Coverage & hours
Qualifications
Services
Labs & platforms
Fees
Billing & sign-off

Leave this field blank

Section

Site & primary contact

Legal entity, physical address, and who we call for scheduling.

Submit one form per physical collection site. Mobile-only collectors: use your dispatch base address and mark “Mobile only” in Section 3.

Legal business name*

DBA / site name for dispatch

Site type*

Federal EIN / Tax ID*

Street address*

Suite / floor

City*

State*

ZIP*

County

NPI / CLIA (clinics only)

Primary contact name*

Primary email*

Phone Number — Business Hours*

Phone Number — After Hours*

Answered nights, weekends, holidays — this is the number our dispatcher calls.

Dispatch / order email

Billing / AR email

Section

Hours & coverage area

Availability, travel radius, and how “after hours” is defined at this site.

Hours — Mon to Fri*

Hours — Sat & Sun

“After hours” is defined as*

Latest walk-in before close

Availability*

Walk-ins accepted
Appointment only
Saturday coverage
Sunday coverage
Holiday coverage
24/7/365 dispatch

On-site / mobile coverage

Performs on-site mobile collections?*

Yes
No

Max travel radius (mi)

Typical STAT response

ZIP codes covered for mobile / on-site*

List ZIPs or counties. This drives which requests get routed to you.

States served

Section

Collector credentials

49 CFR Part 40 qualifications on staff at this site.

DOT urine collectors on staff?*

Yes
No

BATs on staff?*

Yes
No

Certified collectors

Certified BAT / STT

EBT make & model

Additional qualifications

Same-gender observer available
Directly observed collections
Shy bladder protocol
Certified phlebotomist
NRCME examiner on staff
Bilingual staff
Wheelchair accessible
Error correction training current

Languages spoken

Section

Services offered

Specimen types, testing reasons, and kit policy.

Collection types performed*

Urine (UDS) — lab based
Urine — instant / POCT
Breath alcohol (BAT)
Saliva alcohol (SAT)
Oral fluid
Hair
Nail
Blood draw / PEth
DNA (chain of custody)
DOT physical
19-A physical
PPD / TB test
Chest X-ray
Respirator fit test
Audiometric testing
Vaccines / titers

Testing reasons supported

Pre-employment
Random
Post-accident
Reasonable suspicion
Return-to-duty
Follow-up

POCT panels / brands stocked

Will use DTC-supplied kits/CCFs?

Section

Labs & electronic collections

These details help us route orders to sites that support the client’s laboratory and eCCF requirements.

Laboratories you currently collect for*

Quest Diagnostics
LabCorp
Abbott / Alere
MedTox
Clinical Reference Lab
Psychemedics
Omega Laboratories
eScreen
Other

Electronic CCF platforms in use

FormFox
i3screen
eScreen eCCF
Quest ePassport
LabCorp WebCOC
CRL eCCF
Paper CCF only

Quest Preferred Provider (PPN) site?

Yes
No
Unsure

Stocks federal (DOT) CCFs?

Yes
No

Lab account numbers (optional)

Section

Service fees & mobile pricing

Enter your rate to DTC, not your retail price. Enter 0 for anything you don’t charge — rates are held for 12 months from approval.

Collection-only fees

Per-collection charge, no dispatch fee

FEE-UDS
USD Collection Only*

Urine drug screen, collection only — no lab or MRO.

FEE-BAT
BAT Alcohol Screening*

Note below if confirmation testing is included.

Oral fluid collection only

Hair collection only

Instant / POCT collection

Each additional donor, same event

Scheduled on-site / mobile fee

24+ hours notice — dispatch fee, in addition to collection fee

FEE-MOB-BH
Business Hours*

FEE-MOB-AH
After Hours Hours*

Scheduled mobile pricing notes

Immediate service on-site request

Under 24 hour notice

FEE-STAT-BH
Business Hours*

FEE-STAT-AH
After Hours*

Immediate-service pricing notes

Mileage / travel

Beyond your included radius

FEE-MILE
Milage If Applicable*

Enter 0 if mileage is built into your dispatch fee.

Miles included before charge

Minimum trip charge

Measured as

Mileage / travel notes

Optional rates & notes

Observed collection surcharge

Wait time (per hour)

No-show / cancellation

DOT physical exam

Shy bladder / extended monitoring

General rate notes, minimums, and exclusions

Dispatch estimate

What our dispatcher would quote using the rates above — adjust the scenario to sanity-check your pricing.

Notice given

24+ hrs
Under 24 hrs

Time of request

Business hours
After hours

Services performed

UDS collection
BAT screening

Distance from your site

30 mi

Estimated total

$0.00

Section

Billing, insurance & attestation

Completed by an authorized representative.

Payment terms accepted*

Invoicing method

W-9 available on request?*

Yes
No

Carries liability insurance?*

Yes
No

Insurance carrier

Coverage limits

Anything else we should know

I certify that the information submitted is accurate and complete, and that collectors performing DOT-regulated collections at this site meet the qualification and training requirements of 49 CFR Part 40 Subpart C. I understand the rates entered in Section 7 are the rates I will invoice Drug Test Compliance upon approval.*

Signature — type your full name*

Title*

Date*

Submission does not guarantee assignment volume or network placement. Drug Test Compliance may request additional documentation before activation.