Create User Account
Please fill out the form below to register for eScreen Express.
Required fields are indicated with an asterisk (*)
User Profile
Email:
*
Confirm Email:
*
Company Name:
Access Code:
First Name:
*
Last Name:
*
Address 1:
*
Address 2:
City:
*
State:
Please Select a State
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Maryland
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South Carolina
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Tennessee
Texas
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Vermont
Virgin Islands
Virginia
Washington
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Wyoming
*
Postal Code:
*
Phone Number:
-
-
*
Create Password
Password:
*
Confirm Password:
*
Passwords must be between 8 and 15 characters with 1 uppercase letter, 1 lowercase letter, and 1 number or special character.
Customer Type
Please select ONE below that best describes why you chose to use the eScreen drug testing solution (this information will be kept confidential and is not shared or sold):
I am a small business owner and I want to screen my employees
I am an independent owner-operator of a DOT regulated business and I need to screen myself
I am seeking employment and I want to drug screen myself prior to taking a pre-employment drug test
I am seeking education enrollment and I need to be drug screened as part of the application process
I am seeking to sign a property lease and I need to be drug screened as part of the lease approval process
I am a parent of a minor that needs to be drug screened in order to participate in school or extracurricular activities
I am a parent or guardian of a minor that I wish to monitor through a drug screen
I am required by court order to have a drug screen
I am required by a rehabilitation or probation program to have a drug screen
Other
Terms & Conditions
Yes, send me eScreen Sales and Marketing Information.
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to view the Terms and Conditions of use.
I have read and accept the Terms and Conditions of use.
*
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