SAP Evaluation Request
Please complete the following information and a SAP will be in contact with you within 24 hours or less.  We often can schedule your evaluation within 24 hours if during the week. 

 Information shared is private and shared only with Hargrove Counseling staff needed to complete appointment scheduling and/or SAP evaluation.
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Today's date *
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First and Last Name *
What is your date of birth? *
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What is an email address that you check frequently?
(By entering email you give me permission to contact you via email)
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What is a good phone number to reach you at? (By entering phone you are giving Hargrove Counseling permission to contact you via call or text message) *
What was the date of the violation? *
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What type of violation was it? *
Required
What did the test show positive for? *
Required
How did the substances get there? *
What other medications do you take.  Prescription, supplement or over the counter.  (Put none if you do not take any medications) *
What number violation is this? *
What was the company's response to the violation? *
Required
What time of day is good to contact you and/or schedule your appointment? *
Are you a member of the DOT Clearinghouse *
DOT Clearinghouse - Instructions for Enrollment
It is a requirement that all CDL drivers register with the DOT Clearinghouse.  If you have not registered with the clearinghouse, you can click the link below to register.  If you decide to hire me as your SAP,  you will need to appoint Jen Hargrove (Hargrove Counseling LLC) as you SAP in order for me to do your evaluation.    Clearinghouse Registration
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