ONLINE QUOTATION REQUEST

Drug & Alcohol Testing

Upon receipt of your completed form, your request will be dealt with immediately and a quotation will be issued to the appropriate parties as instructed.

For assistance in completing the form, please call us on 029 2048 4141
FIELDS MARKED * MUST BE COMPLETED

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GENERAL INFORMATION
Yes No
1. Donor Details - Please complete the details of the person to be tested
M F
2. Drug Analysis

ISO 17025 UKAS accredited hair drug testing. Please refer to our Service Level Agreement.

Scalp Hair: Scalp hair grows at an average rate of 1cm per month. Therefore a 3cm length of scalp (head) hair corresponds to an approximate time period of 3 months.
The time period that a hair sample can cover is dependent on the length of hair that is available.
Body Hair: Body hair has a slightly slower growth rate than scalp (head) hair and only 50% is actively growing; this renders it unsuitable for estimating time-resolved analysis. Body hair is unsuitable for segmental analysis.

Scalp (Head) Hair Body Hair

Month by Month Analysis: Our laboratory will cut the scalp hair samples into 1 cm sections, each corresponding to a period of approximately 1 month.
Overview Analysis: Our laboratory will cut the scalp hair samples into 3 cm sections, each corresponding to a period of approximately 3 months.
Bi-monthly Analysis:Our laboratory will cut the scalp hair samples into 2 cm sections, each corresponding to a period of approximately 2 months.

Number of Months (1 cm = approx. 1 month):

Sectional Type of Analysis:

Month by Month Bi-Monthly Overview

Other:

Due to the nature of hair, a hair sample may fall below our recommended weight for analysis, as such analysing a hair sample below our recommended weight could make it more likely that a 'Not Detected' result would be obtained. Please indicate how you wish to proceed in this event.

Proceed with all sections Proceed with only the sections that meet the recommended weight Place the sample on hold and explain the options available

Select all (excludes Steroids, Psychoactive Substances, Spice & Anti-Epileptics)

Select most commonly abused drugs

Amphetamine
Anti-Epileptics (Pregabalin and Gabapentin)
Antidepressants
Benzodiazepines
Buprenorphine
Cathinone (Khat)
Cannabis
Cocaine (incl. Crack Cocaine)
Fentanyl
Ketamine
LSD
Mephedrone (M-Cat)
Methadone
Methamphetamines (incl. MDMA & Ecstacy)
Opiates (incl. Heroin)
Pethidine
PCP
Psychoactive Substances ('Legal Highs')
Spice (Synthetic Cannabinoids)
Steroids
Tramadol
Zolpidem (Hypnotics)
3. Alcohol Testing - Assessing Chronic Excessive Alcohol Use

Our hair alcohol test is ISO 17025 UKAS accredited and in accordance with the Consensus of the Society of Hair Testing on hair testing for chronic excessive alcohol consumption. We recommend that hair alcohol testing is used in conjunction with CDT and Liver Function blood tests.

3 Months 6 Months Body Hair (chest, leg or arm)

Includes hair alcohol testing – Ethyl Palmitate (FAEE) & EtG – for 3 or 6 months, blood CDT and liver function testing, an Expert Report for Family Court and a Lextox sample collection.

Hair alcohol test for chronic excessive alcohol consumption

Scalp Hair - Ethyl Palmitate (FAEE) & EtG:

3 Months 6 Months Other:
Body Hair - Ethyl Palmitate (FAEE) & EtG (chest, leg or arm hair):

The blood test for alcohol can be used to indicate recent excessive alcohol use. A CDT test is a biochemical test that can provide biochemical evidence of recent excessive alcohol consumption. A liver function test provides a snap shot in time of liver health damage that may have come from excessive alcohol consumption; however other factors such as medications or health problems may also have an effect on the liver.

Carbohydrate Deficient Transferrin (CDT) Test Liver Function (LF) Test
4. INSTRUCTING PARTY DETAILS – PLEASE INDICATE WHO IS INSTRUCTING THE TESTING:
Legal Aid/Publicly Funded Privately Funded
Yes No

If the cost is to be shared between a number of parties we will send a quotation to each for their share and invoice each for their share after the test results are issued. Each party will be required to authorise their quotation before the sample can be collected.
In accordance with the Legal Aid Agency there is no charge for split invoicing

Legal Aid/Publicly Funded Privately Funded

+ Add Party
5. Expert Report

Please note, an Expert Report will be prepared and charged in all cases where the donor is the Instructing Party.

Yes No

Our Expert Report provides details of the sample analysis, the results and an interpretation of those results and is suitable for use as evidence in court. Our Expert Reports are prepared in accordance with the LAA codified rate. If an Expert Report is not required, you will receive a summary of the results in a covering letter and the Certificate of Analysis, which lists the substances that have been analysed and whether the substances have been detected or not detected, with a concentration value. No interpretation of the results is provided with a Certificate of Analysis. Please note that an Expert Report is not available for blood alcohol testing.

Family Court Civil Court Criminal Court
6. Result Details - Please include details of who will be receiving the results.
Yes No

Please note that the results will only be issued to one party and we will only discuss the results or the progress of the analysis with the party that is receiving the results.
The results and Expert Report are issued on average in 4 working days of sample receipt into our laboratory.

7. Collection Details

Please indicate who will be collecting the sample and the location of where the sample collection will take place.

Lextox Collectors are able to take hair (including body hair) and blood samples. If you choose a Lextox collector, please detail two preferred collection dates and times.
We can arrange the sample collection immediately and usually collect the sample within 48 hours.

Lextox Collector GP Solicitor/Social Worker

Other:



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