Get Collection Site Information Form - Firstlab

The Collection Site Information Form - FirstLab is a crucial document for establishing a collection site. This guide provides a clear and comprehensive overview to help users effortlessly complete the form online.

Follow the steps to complete the form seamlessly.

1. Press the ‘Get Form’ button to access the form and open it in your preferred editor.
2. Begin by filling in your facility's name in the designated field.
3. Provide the address of your facility, including city, state, and zip code.
4. Enter the site contact information. Include the person’s name and provide a phone number and fax number.
5. For billing purposes, fill in the name of the company responsible for invoicing, followed by the billing address and contact number.
6. Include your Employer Identification Number (E.I.N.) and indicate whether you require a 1099 form by selecting ‘Yes’ or ‘No’.
7. List out the fees for various services under the Fees section, such as DOT and Non-DOT drug screens, blood draws, and other tests. Specify the charges for normal and after-hours services.
8. Indicate if you will require additional charges for services such as office testing, emergency cancellations, mileage, or wait time.
9. If applicable, indicate if mobile testing is available and check for certified collectors.
10. Select if your business qualifies as a Minority Business Enterprise or Woman-owned Business Enterprise.
11. Add any relevant notes in the specified area to provide further context to your submission.
12. Sign and date the agreement section, affirming your acceptance of the terms as outlined.
13. Finally, review all entered information for accuracy before saving changes, downloading, printing, or sharing the completed form.

Complete your documents online today for a smoother process.