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, COVID-19 Test Kits, 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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