IPS Drug Testing | DOT Compliance & Drug Testing TPA in Troy, Michigan
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Employer Name
Driver’s Name*
Requester Email*
Driver’s Birth Date*
SSN
Requester Phone*
Add'l Email
CDL Number*
CDL State* —Please choose an option—Choose optionAlaskaAlabamaArkansasArizonaCaliforniaColoradoConnecticutDistrict of ColumbiaDelawareFloridaGeorgiaHawaiiIowaIdahoIllinoisIndianaKansasKentuckyLouisianaMassachusettsMarylandMaineMichiganMinnesotaMissouriMississippiMontanaNorth CarolinaNorth DakotaNebraskaNew HampshireNew JerseyNew MexicoNevadaNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWisconsinWest VirginiaWyomingOther
Email
Reason for Test* —Please choose an option—Please selectNew Hire - Pre EmploymentFollow UpReasonable Suspicious/CausePost AccidentReturn to DutyRandomOther
DOT / Non-DOT* DOTNon-DOT
Type of Test* DrugAlcoholDrug & Alcohol
Observed? YesNo
Paid By Driver* YesNo Please note that the E-Passport will be sent AFTER the driver pays. Please select YES if you want the driver to pay for the drug test.
Other Services DOT PhysicalMVRPSP
Query Request YesNo
We have added Pre-Employment Query as an option for you. It is a DOT Requirement.If you are interested in this services from IPS, please Chose “Yes”.
Type of Request* Select onePre employment
Do you have a Clearinghouse Account ? YesNo
Please login to your Clearinghouse account and select IPS as your C/TPA. Login Clearinghouse Portal
Have you selected IPS as your C/TPA? YesNo
You need a Clearinghouse Account to run queries. To Set up, Click here Clearinghouse Portal
Do you have enough Purchased Queries? YesNo
You need to have at least one Query to complete request. To purchase queries,Login Clearinghouse Portal
Overall Query Comments Please enter your comments here.
Test Location: (The location below will be used to select a clinic)
City*
State* StateAlaskaAlabamaArkansasArizonaCaliforniaColoradoConnecticutDistrict of ColumbiaDelawareFloridaGeorgiaHawaiiIowaIdahoIllinoisIndianaKansasKentuckyLouisianaMassachusettsMarylandMaineMichiganMinnesotaMissouriMississippiMontanaNorth CarolinaNorth DakotaNebraskaNew HampshireNew JerseyNew MexicoNevadaNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWisconsinWest VirginiaWyoming
ZIP*
Comments You may enter a name and address of a preferred clinic where you want to send the driver.
