Send a Referral to Clearlee

Please use the online form below to submit a referral to Clearlee.

Call 205-419-1143 for assistance.

Test Costs

Clients may order any number of tests at a time. Each test is $30 + $10 shipping (per order). Clients are responsible for ensuring they have enough tests on hand.

Referring Court or Agency

State of Court / Agency(Required)

Your Court / Agency(Required)

Your Name(Required)

First Last

Your Email(Required)

Court Case # (Enter 'NONE' if not applicable)(Required)

Testing Starts*(Required)

Completion date(Required)

Number of Tests(Required)

Per (week/month)(Required)

Scheduling(Required)

Please select what type of scheduling you would prefer. You will always be able to cancel, add, or reschedule tests within the Monitoring Portal with any selections.

Comments (Visible only to Clearlee Support)

Client Being Referred

First Name(Required)

Last Name(Required)

Birthdate(Required)

Phone(Required)

Email(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Court / Agency Representative Signature (Type your name)(Required)

Referral Date(Required)

Comments

This field is for validation purposes and should be left unchanged.

*please allow 5-7 business days for testing to begin to accommodate Client onboarding and shipping.

Send a Referral to Clearlee

Test Costs

Referring Court or Agency

Client Being Referred

Title

Company

Programs

Who It’s For

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