Please complete all areas of this request form to ensure that we can provide you with a detailed quotation and note the permanent fields (marked with a red asterisk*) that are required. Upon receipt of your form, your request will be dealt with immediately and a quotation will be sent via fax to the details you provide below. A copy of this form will be sent to the email address you provide for your reference. Please note that the more information you can supply us with, the more accurate our quotation will be.

Note: Information marked with a red asterisk (*) is compulsory

Donor Details

General Information

Delivery of Results & Invoice Information:

Split invoicing incurs a charge of £20.00 + VAT per party. Please provide details upon completion of this form and send in separate documentation to info@trimegalabs.com. We require for all parties: name of firm and fee earner, relevant reference number, address, telephone and fax numbers. We will not be able to split invoices without this information.
Please indicate the number of parties including your firm you wish to split the invoice against:

Updates will be generated by email to the address you have supplied above to notify you on the progress of your test.

Would you like to receive these emails?

Testing kit to be dispatched to/collection location:

Opposing Solicitor Details:

Drug Testing (complete if applicable)

Drugs to be tested for (tick as appropriate)



If you have selected Amphetamines and Methamphetamines, please confirm whether your client is taking any prescribed Amphetamine and specify the name of the medication.

Required duration of drug testing (Select as appropriate)

Test(s) Required (Tick as appropriate)

Alcohol Abuse Testing (Complete if applicable)

Alcohol Questions (Please complete):

Has donor had history of excessive alcohol consumption?


Abstinent since (indicate date if applicable)

Type of test(s) required (Tick as appropriate)

  • Blood Tests:
  • Hair Alcohol Testing:
  • Combined Package:

Adoption Testing Package

The adoption testing package includes all the products listed above (hair drug / hair alcohol / blood alcohol), to provide a comprehensive body of information relating to substance abuse and the adoption process. This covers only standard testing for all tests. If you wish to select this package for adoption purposes, please indicate:

If 'Yes', please ensure that the Trimega Sample Collection section below is completed with the necessary details.

Additional

Expert Witness Statement (Tick as appropriate)

Expert Witness Statement - Trimega Laboratories include within the testing charges a Certificate of Analysis and a summary with an extended report. We can provide an Expert Witness Statement for court purposes as and when it is required that includes the clarification of the diagnostic findings. This is charged at an additional cost and is available for both Drug and Alcohol tests.


Trimega Nurse Sample Collection (Complete if applicable)

Sample Collection - Trimega Laboratories provide a network of collectors who may attend your office or your client's home to collect the sample. The cost of collection is charged as an extra cost if you have not requested for The Complete Package. Please complete the section below if you wish to have your client's samples collected by one of our collectors.


(please note that any appointment dates indicated above are not guaranteed and are subject to collector availability)

Your Details

If your details are different from the details provided in the "Delivery of Results & Invoice Information" section, please provide us with your full name and contact information.