Quiet Authority Client Intake & Service Request

Quiet Authority Group Client Intake & Service Request

Welcome to The Quiet Authority. We provide discreet, professional mobile and remote compliance and screening services for individuals and businesses. Please complete the form below to submit your service request. This information allows us to assess your needs, prepare accurate pricing, and coordinate scheduling efficiently. Please note: Submission of this form does not confirm an appointment. A representative will follow up promptly to review your request, confirm availability, and outline next steps.
Client Information
Are you a first-time client or a returning client?
Thank you

For choosing The Quiet Authority. We’re committed to providing discreet, professional, and reliable compliance and screening services.

Please complete the form below with as much detail as possible so we can accurately review your request and confirm availability, pricing, and scheduling.
Is this request for an individual or for a business or company?
How did you hear about Quiet Authority?

Other
Welcome Back

We Appreciate Your Continued Business

Thank you for choosing The Quiet Authority again. We value your trust and look forward to continuing to support your compliance and screening needs.

Please provide a few details about your previous service so we can quickly reference your history and streamline your request.
Last Service Date (if known)

MonthDayYear
Date
Type of service previously received
Have you used compliance, screening, or testing services like this before?
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Business/Company Name
Business Contact Title or Position
What type of company or industry is this?
Quiet Authority Group supports both one-time and recurring business service needs. Organizations with ongoing testing, screening, or compliance needs may be eligible for account setup, streamlined scheduling, and recurring service coordination.
Type of Business Service Needed:
Requesting Agency, Employer, School District, Licensing Board, or Organization
- Type of Service(s) Needed (Check all that applies)
  
  Other
- Describe the additional service requested or any other details
- Is this an urgent, after-hours, or weekend request? (Select all that apply)
- Estimated number of screenings needed?
- Will services be provided on-site for multiple individuals or arranged individually?
- Preferred Service Date
  
  MonthDayYear
  Date
- Preferred Service Time
  
  Hour Minutes
  
  AM/PM Option
- Alternate date or time preference
  
  MonthDayYear
  Date
- When is service needed?
- Please provide detailed location information to support scheduling, coordination, and service planning.
- Type of Service Location
  
  Other
- Please specify (if other) and/or Additional Details or Special Instructions
  Location Notes, Instructions, Suite Number or Special Entry Information
- Service Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- On-Site Contact Name (if different)
- On-Site Contact Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Drug & Alcohol Detail Section
- Drug & Alcohol Details Please complete any sections below that apply to your requested services. If a section does not apply to your request, it may be left blank unless otherwise noted.
- Reason for Test
  
  Other
- Designated Employer Representative (DER) Name, (Required for DOT)
- Designated Employer Representative (DER) Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Designated Employer Representative (DER) Email Address
- Preferred Laboratory, if available
- DOT Number (if applicable)
- Preferred Medical Review Officer (MRO) Name/Company, if available
- Do you have an existing testing program, consortium, or third-party administrator?
- Name of Existing Testing Program, Consortium, or Third-Party Administrator
- If you already have a designated laboratory or Medical Review Officer (MRO), please provide that information above. If not, Quiet Authority Group, LLC can review the request and discuss coordination options with you if applicable.
- Date of Incident
  
  MonthDayYear
  Date
- Time of Incident
  
  Hour Minutes
  
  AM/PM Option
- Brief Description of Incident (optional)
- Did the employer complete documentation related to reasonable suspicion?
- Is the test associated with a Substance Abuse Professional (SAP) program?
- What to expect - fingerprinting services. Please confirm fingerprinting requirements with your requesting agency prior to your appointment. Bring valid identification in any required forms or instructions. Ensure you know the correct card type and number of copies needed to avoid delays or repeat visits.
- Purpose of Fingerprinting
  
  Other
- Please specify the purpose of fingerprinting
- Type of Fingerprinting Needed
- Number of Fingerprint Cards Needed
- Requesting Agency or Organization
- Please confirm fingerprinting requirements with the requesting agency, employer, court, licensing authority, or organization before your appointment whenever possible. Quiet Authority Group, LLC is not responsible for agency-specific requirements that are not disclosed in advance.
- DNA Testing Please complete any sections below that apply to your requested services. We coordinate DNA services with approved partners; requirements and turnaround depend on the lab. If a section does not apply to your request, it may be left blank unless otherwise noted.
- Purpose of DNA Testing
  
  Other
- Please specify the purpose of DNA testing
- All participants may be required to present valid identification. Depending on the type of DNA testing requested, additional documentation or legal processing requirements may apply. A representative will review your request and advise you of next steps.
- Please confirm background screening requirements with your requesting agency prior to your appointment. Bring valid identification and any required forms or instructions. Ensure you know the correct screening type and number of copies needed to avoid delays or repeat visits. We coordinate background services with approved partners; requirements and turnaround can vary depend on the requesting agency and jurisdictions.
- Background screening services needed: (Select all that apply)
  
  Other
- Specify the purpose of the background screening
- Purpose of Background Screening
- Who is the background screening for?
- When are results needed?
- What Type of Document? (Select One)
  
  Other
- How many signers?
  
  More
- What type of notarization is needed?
- Will all signers be present at the same time?
- Does this document require witnesses?
- Do all signers have valid, un-expired, government-issued ID?
- Valid ID is required for notarization. We will follow up to review options.
- Upload Document (optional)”
  
  Cancelof
- Disclaimer:
  Notary services are limited to verifying identity and witnessing signatures. We do not provide legal advice or prepare documents.
- Business or Company Request Details
- Is the billing address the same as the service address?
- Billing Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Preferred Payment Method
  
  Other
- Billing Contact Name (if different)
- Accounts Payable or Billing Email Address
  example@example.com
- Purchase Order Number, if applicable
- Almost done - we review every request quickly and follow up to confirm availability. Please review your information carefully before submitting your request. By proceeding, you confirm that all information provided is accurate and complete to the best of your knowledge.
  
  Submission of this form does not guarantee an appointment. A representative from The Quiet Authority will review your request and contact you to confirm service details, pricing, and scheduling.
  
  You may click link to review our Terms & Conditions.
- I have read and agree to the Terms & Conditions of Service
- I certify that the information provided is accurate and complete, and I understand that submission of this request does not guarantee service until confirmed.
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Quiet Authority Group Client Intake & Service Request

Client Information

Drug & Alcohol Detail Section

Business or Company Request Details