I,hereby request and authorize Drug Test South San Antonio to release any/all forensic records to the person or entity indicated below by way of the indicated delivery method. Method/Notes I will not share my Password with anyone not listed as an Authorized Recipient. Reasonable efforts will be executed to protect Donor confidentiality throughout the testing process, however I relieve Drug Test San Antonio Employees, Agents, Partners, and Owners of any liability for intercepted: email, faxes, USPS mail, courier service, and/or other transmission methods once communication has been initiated from the office.

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I have provided the following Password that may be used to establish authority to access confidential information concerning this case: *

Authorized Recipient Name

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