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Independent Request

Independent Request

Please review and complete the form below for independent requests.

Once this information has been received, you will be contacted to process payment and to book the appointment.

We can only begin making arrangements for your request upon the return of this form. Payment is required at time of booking by credit card. Please note, we do accept pre-paid credit cards.


Independent Request Form

Independent Request Form For Drug and Alcohol Testing Services

"*" indicates required fields

Contact Information

The individual we contact to process payment and book the appointment
Name*







Donor Information

Individual being tested.
Name*








MM slash DD slash YYYY

Please note that it may take up to 24 hours to schedule testing and requested appointment times are not guaranteed. All tests are booked on a first-come first served basis.

MM slash DD slash YYYY

Estimated Timelines

Lab testing – Samples that screen Negative typically result within 24 hours once the sample is received at the laboratory. Samples requiring confirmation testing typically result within 72 hours.’

Express testing – This is a screening tool only. If the sample is inconclusive and requires confirmation testing, results may take up to 5 business days. Otherwise, results are typically reported out the same day.

Please note – courier delays can be a factor in delivery; this is beyond our control and typically takes 1-3 business days depending on the city of collection.

Please see information below on test types

Excluding Additional Fees

Please Note – Some collection sites may charge additional fees, prices are subject to change based on the collection site available in your area.
All Sales Are Final*

Consent

I AGREE that I am responsible for understanding, the associated protocols as stated in this document and advising the individual scheduled for testing ( if applicable). The information
enclosed is accurate to the best of my knowledge.
Name*








MM slash DD slash YYYY

Additional Information

** Test type selections include the Canadian Model V6.0 drugs and respective cut-off levels below. 

Canadian Model V6.0 Requirements

  URINE Panel Drug Test
** EXPRESS 5
Panel Drug
Test + Semi
Synthetics
Opioids
** 5 Panel Drug
Test + Semi
Synthetics
Opioids
10 Panel
(IOL) Drug
Test
** 10 Panel
Drug Test +
Semi
Synthetics
Opioids
EXPRESS
12 Panel
Drug Test
** 12 Panel
Drug Test +
Semi
Synthetics
Opioids
Illicit
Substances
Tested For
Marijuana (THC)
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Cocaine
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Amphetamine/
Methamphetamine
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MDMA (ecstasy)
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Opiates
(Codeine/Morphine)
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6-Acetylmorphine (Heroin)
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Phencyclidine (PCP)
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Hydrocodone/
Hydromorphone
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Oxycodone
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Oxymorphone
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Benzodiazepines    
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Barbiturates    
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Methadone    
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Propoxyphene      
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Methaqualone      
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Please note that some test methods are NOT APPROVED for all test reasons, please see below. Test Methods Approved for all Test Reasons

  • Urine Laboratory Testing: Gold standard and leading practice within the testing industry. Highest assurance of accurate results. The urine sample is sent to a SAMHSA-certified laboratory for Testing.
  • Express-to-Lab Urine Testing: Two tests in one. Performed with a POCT/Express device at the collection site. The result of the POCT is considered a preliminary result. The urine sample is sent to a SAMHSA-certified laboratory for testing. The urine lab based test is the final drug result. Express-to-Lab testing (Semi-Syn OPI panel) is recognized by Canadian Model for Post-Incident and Reasonable Cause tests only.
  • Breath / Saliva Alcohol Testing: Breath Alcohol testing is most common method used to detect alcohol. If a screening result displays a blood alcohol level at or above a level of 0.020, a breath alcohol confirmation test is required using a evidential breath- testing device (EBT). Saliva alcohol can only be used as a screening device. If the screening result detects alcohol, a confirmation test is required using a evidential breath-testing device (EBT).

Test Method Not Recognized Under the Canadian Model V6.0

  • Express Urine Testing: Prompt results, but not as accurate as a laboratory based test. Performed with a Point of Collection Testing device (POCT) at the collection site. If the sample tests negative, this is the final result. Inconclusive samples are forwarded to a SAMHSA-certified laboratory for confirmation testing.

Test Method Approved for Post Accident/Incident & Reasonable Cause Test Reasons Only

  • Oral Fluid Laboratory Testing: The oral fluid sample is sent to a SAMHSA-certified laboratory for Testing. Canadian Model advocates for its use in Post-Incident and Reasonable Cause testing.
  • Urine Screen and Oral Fluid Lab Testing: Two tests in one. A urine screen is performed with a POCT/Express device at the collection site. The result of the POCT is considered a preliminary result. The Oral Fluid sample is sent to a SAMSHA-certified laboratory for testing. The Oral Fluid lab based test is the final drug result. This tests two biological fluids with different detection windows, which can yield different results. Recognized by Canadian Model for Post-Incident and Reasonable Cause tests.

*Note: currently there is no instant oral fluid device with FDA approval that also tests to the approved cut-off levels.

Receiving Results

  • Only the individual who is tested can access results or authorize a release of the results to another individual.
  • This is done by filling out a Request for Release Form at the collection site, or they may choose to print a clearance online at www.cannamm.com.
  • If printing a clearance online, the following steps will need to be completed:
    • From the CannAmm home page, select ‘Request Clearance Letter’
    • Enter your specimen ID number (located on the top of your copy of the chain of custody form provided by the collector)
    • Enter your surname (last name)
    • This will populate a PDF of the clearance letter that can be emailed, saved or printed.

Important Information For Appointment

  • Bring government-issued photo identification to the appointment.
  • Be prepared to provide the required sample (urine, breath, or saliva) at the time of the appointment.
  • The collection process for urine sample may take up to 3 hours to complete.
  • Children will not be allowed at the collection site unless supervised by someone other than yourself or site staff.
  • For additional information, please see our website: https://www.cannamm.com/employees/preparing-for-your-appointment/
  • If you need to reschedule, or cancel, please advise CannAmm as soon as possible by calling 1.800.440.0023 option 4,
    or by emailing independents@cannamm.com (at least an hour’s notice) to avoid possible charges.