The Consortium, Inc.
Drug Testing and EAP Contracts Department
e-Comments Form
Your Name (Optional):		Agency/County (Optional):
You Are (Select One):	Select an item from the list Client Family Member Provider or practitioner Contractor(Company) Designated Employer Representative Applicant for Employment Other
Would you like to be contacted in reference to these comments? Yes No
If Yes, please contact me by: (Select One)
Email - my address is:
Telephone - my number is:
Regular Mail - my address is:
Type of Comments(Please mark all that apply to your complaint):
Program Implementation: Contract Information Policy Information	Collection Site: Cleanliness Staff Behavior Paperwork Integrity of testing process Waiting Period Accessibility Other
Post-test Process: Untimely return of paperwork Question test results Customer Service Other
Training Access Issue: Explain in box below	Other: Explain in box below
* You may enter information in the box below, even if you did not mark any items above.*
Please Explain Your Comments in the Box Below: