Forensic Chain of Custody Form Supporting Lab Testing Samples as Potential Judicial/Forensic Evidence

By mail Certified Lab Testing Including Paternity / DNA / Immigration / Toxins / Poisons / Date Rape Drugs/ Heavy Metals and more

 

 THE CARLSON   COMPANY LLC    

 FREE real person client care 7 days a week  7AM - 10PM MST

 

US and Canada FREE Call - 1-866-889-3410          Inter. +1-011-719-531-6666             Fax 719-886-4827 (24/7)

  

 Disclaimer: The Carlson Company LLC is not licensed to practice medicine or law

 

Why should I submit a Chain of Custody Form?

Chain of Custody defined is the unbroken trail of accountability that ensures the physical security of samples, data, and records having evidence potential in a civil or criminal investigation.

*We suggest that you consider a disinterested third party to witness your sample collection and sign off on the CC form below. You might also have someone take a picture or two clearly showing you as the sample donor as additional evidence of your sample collection. Your pictures will be retained with your case file for future use should you need them.

Questions 1-866-889-3410 (toll free) or

  We strongly recommend that you submit a Chain of Custody form with any test samples that may have an evidentiary potential regarding alleged foul play or a future criminal suit. 

The submission of a completed "Chain of Custody" form is not required to evaluate your lab test sample (s). 

The choice is yours.

 

To print the Chain of Custody form below left click to highlight, then right click, select print selection, then click print

Please print all text between the Begin CC print form and  End CC print form prompts

 

  Begin Chain of Custody print form here

Updated 04/17/08

The Carlson Company LLC

www.thecarlsoncompany.net

6660 Delmonico Dr.   Suite 425   Colorado Springs, CO 80919-1899

 

Request for Lab Test Evaluation of Physical Samples with Chain of Custody

Some requested information may not apply to your case.  If not, leave that space blank.

Please complete this form and submit with your test sample (s)

 

Suspected Incident Date_____/______/_______ ( Re: date rape drug - poisoning)

Sample Submission Date_____/______/_______

Sample Collection Date_____/______/________

Sample Donors Age________________________

Sample donor’s name (print) ________________________________________________________________________

Street Address:___________________________________________________________________________________

City _______________________State __________________Zip______________ Phone_________________________

Email____________________________________________________________________________________________

Brief description of sample(s)________________________________________________________________________

Test sample (s) for: circle your choice - toxin/poison/unknown scan - heavy metal scan - infidelity - hair nutrients -

DNA extraction/comparison - date rape drug panel (ketamine, rohypnol, GHB) - Five (5) or Ten (10) panel drug test as

described at www.thecarlsoncompany.net/drugs.htmlIf you are seeking testing services for a

 specific toxin or poison, cremains, post mortem tissue samples or a special DNA evaluation please explain below.

_________________________________________________________________________________________________

_________________________________________________________________________________________________

Brief scenario about this case________________________________________________________________________

_________________________________________________________________________________________________

If applicable, list specific prescription or non prescription drugs formerly or currently being taken by the sample

donor in the past six (6) months______________________________________________________________________

_________________________________________________________________________________________________

Witness to sample (s) collection* See comment above

Name (print) _____________________________________________________________Phone__________________

Signature ________________________________________________________________Date___________________

Email___________________________________________________________________________________________

Chain of Custody

***Party submitting the sample (s) must sign and date immediately below to meet Chain of Custody requirements

Name (print) ____________________________________________________________________________________

Signature ______________________________________________________Sample mail in date________________

Email________________________________________________________________ Phone______________________

Lab Use Only____________________________________________________________________________________

Sample received by ______________________________________________________Date____________________

Sample released by ______________________________________________________Date____________________ 

Sample received by ______________________________________________________Date____________________ 

Sample released by ______________________________________________________Date____________________

Sample received by ______________________________________________________Date____________________ 

Sample released by ______________________________________________________Date____________________

 

End Chain of Custody print form here - revised 02/26/08

__________________________________________________________________________________________________________________________

 

Please include your testing fee with your sample submission

Mail your check or money order with your sample(s) made payable to The Carlson Company LLC

Prefer to pay with your credit card?  We accept all major credit cards (use the form below)

 

 Begin credit card information print form here

 

Cardholders Name________________________________________________________________________________

Cardholders Address_______________________________________________________________________________

City _____________________________________________________State ________________ Zip_______________

Phone Number_____________________________________________

Email Address_____________________________________________________________________________________

Acct.#____________________________________________________

Exp. Date      __/_____ ___

Card Identifier Number_______________________(3 or 4 digit card number - see example below)

Amount________________

Authorized Signature (required)______________________________________________________________________

  Optional Chain of Custody end print form here to include credit card information for fee payment 

 

 

 

Hair sample collection guidelines

  • If possible, wear latex examination gloves when collecting hair samples.
  • Use a sharp pair of scissors or a safety razor cleaned with a rubbing alcohol swab or rinse.
  • The hair shaft samples should be taken as close to the scalp or nape of the neck skin as safely possible. Try to collect a group of hair shafts from the nape of the neck and/or scalp at least a ¼” in. in diameter (minimum) when held between the thumb and finger.  If you can not provide this amount send whatever amount you have or call us toll free at 1-866-889-3410.  Since the hair is homogenous
  • you can collect the hair strands from a variety of scalp or neck locations depending on the donor's hair style. If you wish you may also send pictures of the sample collection showing the face of the donor. Be sure to use a time/date stamp camera.
  • Place the collected hair shafts (scalp/skin ends) into the center of a small piece aluminum foil about 2 inches square then fold the foil up around the hair shafts to identify the scalp end for our lab personnel.
  • Place the foil wrapped hair strands into a clean, unused, mailing envelope which contains the name of the sample donor and/or submitter plus their address, phone number and email address on the face of the envelope. 
  • Place the completed Chain of Custody form, the sample or samples, your credit card information, see below, or a check or money order payable to The Carlson Company LLC in a second envelope addressed to:

     The Carlson Company LLC    6660 Delmonico Dr.   Ste. D-425    Colorado Springs, CO 80919-1899

               

Proper collecting, handling, packaging, and shipping of submitted test samples

      All submitted samples are to be protected from contamination and leakage as best possible.  Some samples may require refrigeration or freezing to preserve their integrity.  Not sure? Call us toll free at 1-866-889-3410.

  • Place non-liquid samples, e.g. hair and nails, in an unused white mailing envelope and seal. 

  • Print the name of the sample donor on the face of the envelope plus their or your address, phone number, and email address. 

  • Please refrain from the use of plastic bags for all sample storage and shipping excluding liquids since plastic can trap moisture and possibly  compromise the integrity of the sample by aiding in the production of mold and bacteria. 

  • Liquid samples should be shipped in a suitable leak proof container with the cap taped to the container to insure against leakage.

  • The amount of sample required for most powders and liquids is 4-6 tablespoons ideally.

  • We suggest that you ask your local pharmacy for a suitable leak proof shipping container for your sample.  New prescription containers are reasonable sterile as well as durable for shipping purposes.

 

 
 

 

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Our General Manager's Comments

Your privacy is our mandate!  

Our client's comments

We accept checks, money orders, major credit cards, EFT (electronic funds transfer).

We do not offer on line credit card processing and we do not accept PayPal to protect our clients from illegal credit card transactions.

 

Our mailing address is

 The Carlson Company LLC      6660 Delmonico Dr.       Suite D-425       Colorado Springs, CO 80919-1899

The Carlson Company LLC is woman owned LLC

 Dunn and Bradstreet Number: 029692303

   Copyright, The Carlson Company LLC     2002-2007  All rights reserved   

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