Report Recipient Form

Please complete this form to update or add report recipients to your client account with USDTL. Forms must be submitted by an Authorized Contact on the account. All contacts added to the account are considered authorized contacts.

* Required

Client ID *

Client Name *

Please specify whether the recipient is replacing someone else in our system. If not, please leave blank.
Replacing Recipient

Enter the name of the contact to be removed from our system (Required if replacement recipient is selected)

New Contact Information:

Salutation *

First Name *

Last Name *

Company/Organization *

Job Title *

Department *

Country *

Address *

City *

State *

Zipcode/Postalcode *

Phone *

Secured Fax

Email *

Does this person need to receive invoices? [select if yes]

Does this person need to receive testing results? [select if yes]

Does this person need to be notified of specimen issues? [select if yes]

Is this person authorized to submit an electronic test order (Electronic Chain of Custody)? [select if yes]

Is this person a licensed Medical Review Officer that needs to receive ALL results? [select if yes]

Is this person a licensed Medical Review Officer that needs to receive POSITIVE ONLY results? [select if yes]

Would this person like to receive marketing communications such as:
Educational Events, Newsletters, New Assay Launches, Changes to Services, etc.? [select if yes]

Disclaimer: By typing your name in the box below, you are acknowledging that (1) you are an Authorized Contact on the USDTL client account and (2) this electronic signature will be in place of your hard copy signature. If you prefer to submit a hard copy signature form for your records, please contact client services.

Authorized Contact Name *

Authorized Contact Email *

Contact USDTL

1.800.235.2367