COVID-19 Test Pickup & Delivery Booking Form

Submitting Request: please wait

FACILITY DETAILS

Facility Name *

Street Address *

City *

State *

Zip Code *

YOUR DETAILS

First Name *

Last Name *

Email Address *

Phone # for voice contact *

Phone # for SMS *

JOB DETAILS

Do You Have A Lock Box? *

Specimens To Pick Up?: *

Number of Specimens *

Location of Specimens *

Name of Contact *

Phone # of Contact *

Do You Need Supplies? *

Please note: Supply requests are reviewed by our Logistics Team; current inventory on record for your facility will be reviewed to determine appropriateness of request.

# of Tubes

# of Swabs

# of Cryoboxes (fit 64 tubes)

# of Specimen Bags (pack of 30)

# of Printer Labels (pack of 160)

1 I acknowledge that the deadline to submit a request is 5:00 PM and if a request is submitted after 5:00 PM the pickup will not occur until the following day
2 I acknowledge that the couriers will perform pickups between the hours of 6:00 PM and 12:00 AM
3 I acknowledge that the couriers will only be given samples under the Broad system and the employees who will be present will be informed of where the samples are located.
4 I acknowledge that I am liable for the release of samples to another courier service or lab. All Pro EMS Solutions couriers will have identification Pro EMS.

Please note any additional considerations for our logistics team

1	I acknowledge that the deadline to submit a request is 5:00 PM and if a request is submitted after 5:00 PM the pickup will not occur until the following day
2	I acknowledge that the couriers will perform pickups between the hours of 6:00 PM and 12:00 AM
3	I acknowledge that the couriers will only be given samples under the Broad system and the employees who will be present will be informed of where the samples are located.
4	I acknowledge that I am liable for the release of samples to another courier service or lab. All Pro EMS Solutions couriers will have identification Pro EMS.