Consent andauthorization for disclosure to clients of Veracity Field Services of alcoholand drug test results and related information

Consent and Authorization for Disclosure to Clients of Veracity Field Services of Alcohol and Drug Test Results and Related Information

Veracity Field Services
Date & Time
I hereby consent to disclosure by Veracity Field Services and its agents, including, but not limited to, any collecting and testing agencies, of the test results identified above and any related information to clients of Veracity Field Services and its authorized agents, assigns, or representatives.
Employee Name

First NameLast Name
Social Security Number (Last Four)
Employee Signature
Should be Empty:

Consent and Authorization for Disclosure to Clients of Veracity Field Services of Alcohol and Drug Test Results and Related Information