For providers, facilities & employers

Provider intake form

Tell us about your organization and what you need coordinated. We typically respond within one business day.

Clinic, nursing home, staffing agency…

e.g. ASAP, within 30 days

Services needed *

Volume, schedule, locations, compliance deadlines. No patient health information, please.

Or call 866-614-6930 ext 4

This form is for healthcare organizations, facilities, and employers. Patients should book at TeQDraws. Do not include protected health information.