Request for Services

Request for Services

Thank you for your interest in the services offered by Intrinsic Environment, Health & Safety. We are working to support skilled nursing and other long-term care facilities to build and maintain the infection prevention infrastructure necessary to support resident, visitor, and facility healthcare personnel safety. As of February 23rd, 2024, these services are no longer funded by the CDPH and cannot be provided free of cost. However, we are still equipped to support your facility with our services. Please fill out the form and one of our team members will be in contact with you as soon as possible with next steps.
Name*

First NameLast Name
E-mail*
Phone Number*
How did you hear about our services?*

Intrinsic EHS WebsiteLinkedInSearch Engine (Google, Bing, etc.)EmailBlogRadio AnnouncementNewsletterRecommended by a colleague/professional acquaintanceOther
Facility Name*
Facility Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Briefly describe your occupation/role within the facility.*
Which of the following best describes your facility?

Skilled Nursing FacilityLong-Term Care FacilityAssisted Living/Residential Care FacilityContinuing Care Retirement Community (CCRC)Intermediate Care FacilitySubacute Care FacilityMemory CareHospiceOther
Please select the service(s) that you are interested in receiving for your facility. A complete description of the services we provide can be found here. Our team will attempt to work through the services with as minimal time committment from your staff as possible. However, we ask that on the day of services, one staff member dedicate at least 15 minutes of time to support our staff with set up and other logistics.
Fit-Testing

Fit Testing (0-25 employees)Fit Testing (26-50 employees)Fit Testing (51-75 employees)Fit Testing (76-100 employees)Fit Testing (101+ employees)
Ventilation

Ventilation ScreeningComprehensive Ventilation Assessment
Any additional comments/questions?
Thank you!

We will reach out to follow up about your request for services.
Should be Empty:

Request for Services

Thank you!