Referral Form Please complete the following form to request an appointment. Please also note that availability will vary depending on your request. Your appointment will be confirmed by phone by a member of our staff. Thank you!Donor Name*Donor Email Donor Phone*Company Name*Authorized By*Company Phone*Must Test By Date* Party Responsible For Payment*CompanyDriverSelect Test Type Federal Drug Test Check All That Apply Select All Drug Alcohol NON Federal Drug Test Check All That Apply Select All Drug Alcohol Reason For Test (Select One)Pre EmploymentRandomReasonable Susp.OTHERIf OTHER, Please ExplainEmployees are strongly encouraged to refrain from caffeinated drinks, alcohol and smoking 12 to 24 hours prior to their DOT examination, as they can increase their blood pressure by 30 points. Choose this location Visit Dr. Nicola, Dr. Vaughan or Dr. DiOrio Dr. Nicola, Dr. Vaughn & Dr. DiOrio 7380 W. Sahara Ave. #100 Las Vegas, NV 89117 Hours: Monday - Friday: 8:45 am - 4:00 pm (Closed 11 am to 2 pm) P: 702-252-7246 F: 702-251-9650 Visit Dr. McElvany Dr. McElvany 861 N. Nellis Blvd. Ste 5 Las Vegas, NV 89110 Hours: Monday, Wednesday & Friday: 9:00 am - 4:00 pm (Closed 11 am to 2 pm) *This office does not do Alcohol Tests or FCE. P: 702-998-6740 F: 702-476-4661CommentsThis field is for validation purposes and should be left unchanged.
