Tox Discovery Form Client*Type Of Facility*Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneFaxAdditional InfoNotesTesting DetailsType Of Testing Needed Drug Confirmation testing only Drug screen reflexed to drug confirmation (PCR) Collector Need Hired? Keep Existing: Paperwork And Urine And Have Been Collected And Sent In Collector NameCollector PhoneCollector EmailApproximate Weekly Collection VolumeCollection Day(s) Monday Tuesday Wednesday Thursday Friday Shipping Courier Route FedEx Pick Up 2 Hr. Window For Pick Up:(Example: 9:00am – 11:00am)4 Hr. Window For Pick Up:(Example: 9:00am – 1:00pm)Latest Time For Pick Up:(Example: 11:00am)Sales Rep*Please contact tox@ildp.com with any questions.CommentsThis field is for validation purposes and should be left unchanged. Get In Touch We would love to hear from you! Whether you are a health care provider or patient, our expert team is here to answer all your questions.