Eurofins Forensic Services Online Submission Form

Please complete the form below to place an instruction for toxicology testing, upon receipt of your request one of our customer service representatives will contact you shortly. Should you have any questions regarding the different tests available? Or about the testing process itself please call 0800 970 8400.

Please provide following information( * Fields are mandatory )
Customer Information:
Instructing Solicitor: *
Instruction firm: *
Address: *
Telephone No: *
Email: *
Donor Information:
Donor Name: *
Date of Birth: *
Contact Number: *
Testing Required – Tick as appropriate:
Standard Drugs of Abuse: Unusual Drugs of Abuse:
Amphetamines * Methadone
Benzodiazepines Methylamphetamines
Cocaine Opiates
Cannabinoids ETG (alcohol)
Buprenorphine Pethidine
Barbiturates    
Fentanyl Others:
Ketamine
Detection Period: Segmental Analysis Required:
1 Month 3 Month 6 Month
9 Month Other
1 Segment 2 Segment 3 Segment
4 Segment Other
N.B. On average human hair will grow approximately at a rate of 1cm per month. Therefore the length of hair segment requested will determine the detection period of the sample. e.g. One 1cm segment = 1 month, One 3cm segment = 3 months
Sample Collection Details:
Eurofins Forensic Services Sample Collector (£95 + VAT) Expert Witness Report (£110 + VAT)
Kit to be sent to (tick as appropriate):
GP Solicitor
Testing Kit to be Sent to:
Name:
Organization:
Address:
Post Code:
Telephone No.: *
Fax No.:
Results and Invoice Information:
Results to be sent to:
Instructing Solicitor Opposing Solicitor
Both  
       
Invoice to be sent to:
Instructing Solicitor Opposing Solicitor
Both  
 

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