COVID-19 Testing Startup

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To expedite the process of rolling out COVID-19 testing, Aculabs has set-up the below form for facilities to fill out in order to make the onboarding process even easier. Further questions can be sent to our team at info@aculabs.com.

Facility Info
Staff Info
Unit Info
Courier Info

FACILITY CONTACT INFORMATION

Name of Facility (required)

Address Line 1 (required)

Line 2

City (required)

State (required)

Zip Code (required)

Your Name (required)

Your Email (required)

Corporation Name [or Privately Owned] (required)

Anticipated Start Date (required)

Medical Director

MD NPI #

Aculabs CSR

Administrator Information

Administrator's Name (required)

Administrator's Email (required)

Director of Nursing Information

Director of Nursing's Name (required)

Director of Nursing's Email (required)

Business Office Information

Business Office Contact - Name (required)

Business Office Contact - Title (required)

Business Office Contact - Phone (required)

Business Office Contact - Email (required)

IT Department Information

IT Department Contact - Name (required)

IT Department Contact - Title (required)

IT Department Contact - Phone (required)

IT Department Contact - Email (required)

FACILITY UNIT INFORMATION

Facility Phone Number (required)

Facility Fax Number (required)

Would you like your results faxed to this number?: (required) YesNo

Please list your facility's units, room numbers associated with each unit, and fax number for each unit. (required)

SPECIMEN COLLECTION INFORMATION

Aculabs Specimen Box Location: (required)

Special Pick-Up Instructions:

If specimen box is located inside, does building ever lock?: (required) YesNo