Mobile On-Site Service Lead Form | Injury Care Associates

Plan Selection Which plan are you interested in?

Standard ($50/month)

Custom Plan

Not sure - help me decide

Contact Information

First Name*

Last Name*

Email Address*

Phone Number*

Job Title/Role

Company Information

Company Name*

Industry*

Company Size*

Number of Locations

Service Needs What services are you most interested in?

Select all that apply

On-site first aid and injury care

Nurse triage line

Drug and alcohol testing

Employee health screenings

Respirator fit testing

Vaccines and immunizations

Other

Operational Details

What are your typical operating hours?

Select all that apply

Monday-Friday, standard hours (7am-5pm)

Extended weekday hours (before 7am or after 5pm)

Weekend operations

24/7 operations

Approximate number of workplace injuries per year

Do you currently have an occupational health provider?

Yes

Additional Information

Tell us more about your needs or ask any questions:

Consent & Submit

I agree to be contacted by ICA regarding on-site services