Request Services or Information - Nursing Home and Long Term Care Facilities Strike Team and Infrastructure Project

To request any of our free services including an ICAR consultation, training, N-95 Fit Testing, COVID-19 Vaccinations, or to have the UAB LTC Strike Team IP Contact you, please fill out the form below. Include as many details as possible and we will respond to your request in a timely manner.

If you have any problems filling out this form please contact us at ltcstriketeam@uab.edu. We will be glad to assist you.

ICAR Request Form

Name:

Your Job Role/Title:

E-mail Address:

Phone Number:

Facility Name:

Type of Care Provided By Facility (select all that apply): Type of Care Provided By Facility (select all that apply):

Address:

City:

County:

State:

Preferred method of contact:

Phone

E-mail

Request Topic: Request Topic:

You can select multiple

Please Provide Any Additional Information:

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