SCLabPatientDropFormUpdated060315
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SC Lab Testing Services
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HPRC Patient Sample Form
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To Be Completed By Patient:
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Date:
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Patient Name:
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Patient Contact Info:
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Product Sample Name:
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(Unique name identifying product and maker)
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Product Type:
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(Flower, Tincture,Concentrate, Edible)
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Actual Product Weight/Volume:
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(grams, ml, etc.)
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Report Unit of Measure:
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(% of Weight, Mg per Gram, Mg per Liter)
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Requested Tests Please Circle All That Apply:
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Potency Test
$40
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Edible Potency Test
$60
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Pesticide Tests
$60
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Microbiological Test
$60
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Residual Solvent Test
$80
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Terpene Test
$100
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SC Lab Info:
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Lab located in Santa Cruz, CA
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Turn-Around Time is 7-10 days
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Drop cutoff is weekly Saturday at 6pm.
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Minimum Sample Requirement Per Test:
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Flower:
1.5 Grams
Tincture: 5ML
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Concentrate: 0.5 Grams/Test
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To Be Completed By Staff:
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Amount Paid:
$
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Employee Initials:
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