L&E - Day of Needs Form

Day of Needs Form
Location
Facility*
Charlotte Address
Cincinnati Address
Columbus Address
Denver Address
New York City Address
Raleigh Address
San Francisco - East Bay Area Address
St. Louis Address
Tampa Address
Date of Study - Start Date*

MonthDayYear
End Date*

MonthDayYear
Requester Contact
Requester Name

First NameLast Name
Email
example@example.com
Moderator Contact
Is the Moderator Contact the same as the Requester?

YesNo
Moderator Name

First NameLast Name
Phone Number

Area CodePhone Number
Email
example@example.com
On-Site Contact
Is the On-Site Contact the same as the Requester?

YesNo
Is the On-Site Contact the same as the Moderator?

YesNo
Onsite Contact Name

First NameLast Name
Phone Number

Area CodePhone Number
Email
example@example.com
Project Requirements
Please select an option

Use Client Form - Attach HereUse L&E Form
Upload Files Here

Browse Files

Cancelof
Arrival Time

:HourMinutesAM/PM Option
# Clients Expected*
Approximate number of clients expected on-site, including moderator
Room Setup Options

Living Room set upConference Room set upOther Options
Room Setup Options (Other Options)

Dial testMock juryTheater seatingWork/computer stationsSpecial Requirements
Room Setup Options (Special Requirements)

Gondola ShelvingDisplay TablesAdditional setup time and storage areaOther
IT Requirements
Recording Request

Digital Audio Only - (emailed) included at no extra chargeDigital HD Video with AudioMAC Compatible Files RequiredOther
Email HD Video To
example@example.com
Email Audio To
example@example.com
Additional AV Services

L&E Streaming with 360° cameraL&E StreamingFocus VisionTranscription ServicesLaptopsTVMonitor
Size of TV
Notes
Include any other details here.
Quantity of Monitors
Notes
Include any other details here.
We need transcription servicesWe do not need transcription services, please email the digital audio recording.
Email Transcription To
example@example.com
Please choose an option for transcription

VerbatimEditedSummarized
Email Audio To
example@example.com
Quantity of Laptops
Facility Requirements
Please let us know what items you require

RescreenerCDA/NDAHomeworkTent CardsName BadgesEasel & Flip ChartClient will be shipping materials to the facility before the study
Type of easel pad

Regular Flip ChartPost It Note Flip Chart
Would you like to attach your Rescreener?

YesNo, we will send later
Please attach Rescreener here

Browse Files

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Are copies of the Rescreener needed?

Yes - L&E will provide copiesNo - Client will provide copies
Who provides the CDA/NDA?

Use L&E verbiage on sign-in sheetClient will provide
Would you like to attach your CDA/NDA?

YesNo, we will send later
Please attach CDA/NDA here

Browse Files

Cancelof
Are copies of the CDA/NDA needed?

Yes - L&E will provide copiesNo - Client will provide copies
TV/DVD Player (Size of TV)
TV/DVD Player (AV requirements)
TV/DVD Player (Specific laptop hookup connection)

Need VGA cordNeed HDMI cordNeed Flash DriveHave a MAC computerOther
We are only able to accept packages at our facilities from 9am to 5pm Monday-Friday unless you make prior arrangements with the Customer Service Manager at the facility you are shipping to.
Facility Address
Materials Details
Include specifics such as the arrive date of shipment.
Food Requirements

In addition to lobby snacks, please provide our respondents with:
Food Options for Respondents

Respondent deli trays (recommended for mealtime groups)Other
Deli Trays (Time to Serve)
Food Options for Clients

BreakfastLunchDinnerSnack TrayOther
Breakfast Time to Serve

:HourMinutesAM/PM Option
Breakfast Options

Hot Breakfast (restrictions may apply)Continental Breakfast
Continental Breakfast (Request Items)
Lunch Time to Serve

:HourMinutesAM/PM Option
Lunch Options

Ordering from on site menusCatering/pre-ordered food
Lunch Catering

Please send menus/suggestionsOther
Dinner Time to Serve

:HourMinutesAM/PM Option
Dinner Options

Ordering from on site menusCatering/pre-ordered food
Dinner Catering

Please send menus/suggestionsOther
Snack Time to Serve

:HourMinutesAM/PM Option
Snack Options

Veggie TrayFruit TrayCheese Tray
Food allergies/sensitivities (please specify)
Notes
Should be Empty:

Day of Needs Form

Location

Requester Contact

Moderator Contact

On-Site Contact

Project Requirements

IT Requirements

Facility Requirements

Food Requirements