New Client Intake

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Fields

Company Name:*

Location:*

Company Contact Name: *

Phone*

Email*

Type of Client:*

Employees Staff Students Vendors

Other: Other Value

Services Requested: *

Advisory/Navigational/Educational Services Alcohol and Urine Drug Screening (e.g., DOT and non-DOT) Blood Borne Pathogen Exposure Management COVID-19 Screening (Antibody and PCR testing) Immunizations/Vaccinations (Hepatitis A, Hepatitis B, MMR, Seasonal Influenza, Varicella) Laboratory Services (Phlebotomy - Titers (HBV, MMR, Varicella, etc.) Medical Visits (Pre-Employment , Return to Duty, Telemedicine, Worker’s Compensation, Illness Verification) OSHA Respirator Medical Clearance and Fit Testing Student Health Services

Other: Other Value

Location of Services *

Client Company Mount Sinai

Other: Other Value

Additional information

We will respond to your inquiry within 24-business-hours and provide additional details.

If you have any further questions or concerns, please don’t hesitate to reach out to BusinessHealth@mountsinai.org or call 212-420-2882.

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