COVID-19 Service Request
I am seeking services for
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A Production Company
Other
Choose a state
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Massachusetts
New York
California
Other
First Name
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Last Name
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Phone Number
Other Relevant Phone Numbers
Your Email
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email
Production Company Name
Project Name
Type of Project
Your Position/Department in This Production
If you are submitting this on someone else's behalf, please indicate their name here
Which Covid-19 Services Might You Need for Your Project (Check All that Apply)
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CONCIERGE Lab-Based PCR (10-16hr TAT)
CONCIERGE Rapid PCR (30-60 min TAT)
CONCIERGE LAMP (molecular) (30 min TAT)
CONCIERGE Rapid Antigen (approx 20 min TAT)
GROUP Lab-Based PCR (12-24hr TAT)
GROUP Rapid PCR (30 min TAT)
GROUP LAMP (molecular) (30 min TAT)
GROUP Rapid Antigen (approx. 20 min TAT)
HOME PCR Testing - SALIVA [Kit(s) Mailed to Your Location]
Please Provide an Estimate of the TOTAL NUMBER of each test needed
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What is the Longest COVID-19 Test Result Turn-Around-Time (TAT) That You Are Willing To Use (If Applicable)
Less than 1 hour (Rapid Tests)
Less than 24 hours
24-36 Hours
List Dates (or Date Range) for Testing and Any Info About Testing Site Locations (If Applicable)
If someone recommended SetMD to you please let us know who it was!
Production Company Street Address
Production Company Street Address Line 2
Production Company City
Production Company State
Production Company Zip Code
NAME of COVID-19 Officer(s) Approved To Access Cast and Crew Lab Results (First Name)
Email addresses of COVID-19 Officer(s) Who Will Need To Be Approved Access to Cast and Crew Lab Results
Accounting Dept. Contact (Name)
Accounting Dept. Email
Anything Else You Would Like Us To Know? Please leave any comments, or even feedback on this form below! (optional)
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