screenings4u l Post Accident Testing

POST ACCIDENT

1. Complete the form below.

2. Receive a call from one of our friendly staff members.

3. We send a mobile collector to your location.

4. You receive all results via your account.

Request Service

We do not bill for this service; all payments are due before we come out. We appreciate your understanding.

Our address is 3317 W. 95th St., Evergreen Park, IL 60805. We only travel no more than 25 miles from this address.

Your Information

First name

Last name

Email

Phone

Your Position

Are you the DER?

Employee or Contractor Information

First name

Last name

Phone Number

Our mobile collector will use this number to communicate with this person.

Vehicle Information

Year

Make

Model

Color

Is this a semi truck?

Location Information

Name of location where the employee or contractor is located

Address

City

State

Zip Code

Phone Number

Requested Tests

What test do you want performed?

Select all that apply

You agree that you are authorized to complete this form.

You give us consent to contact you and everyone listed on this form.