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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
Disclaimer: The Carlson Company LLC is not licensed to practice medicine or law
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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
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
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Begin Chain of Custody print form here Updated 04/17/08 The Carlson Company LLC 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.html . If 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
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Hair sample collection guidelines
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? 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 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 Update
05/01/08 |
COMPANY LLC
