Request a Quote Below is our quote form. The more information you provide, the more accurate our quote will be. Thank you for your interest! If you have any questions, you can email email@example.com Contact and Company InformationYour Name *Company Name *Email Address *Phone NumberCompany AddressStreet AddressSuite or Office #CityState/ProvinceZIP / Postal CodeService DetailsHow many company locations need onsite services?What services are you interested in? *Hearing TestingRespirator Medical ClearanceRespirator Fit TestingPhysical ExamsProfessional Supervisor ServicesThe fields below are all optional. If you don't have these details ready, just click "Request quote" now and the form will submit. Hearing TestingHow many total workers need a hearing test?What are the shift(s) of the workers?When would you like to schedule onsite hearing testing?Within the next two weeksBefore the end of the current monthBefore the end of the next monthBefore the end of the current yearOtherDoes your company currently use a local medical clinic for hearing testing?Has your company ever used an onsite mobile testing vendor to provide hearing testing for your workforce?Additional comments or questions regarding on-site hearing testing services:Respirator Medical ClearanceHow many workers need to be medically qualified for respirator use?We offer an on-line respirator questionnaire “RMEQ Online” which provides immediate clearance status upon completion of the questionnaire online. Would RMEQ Online be a good fit for your workforce?YesNoUnsure - I would like more information about this option.If not, we also offer the traditional “paper version” which may be sent to our office. Do you prefer the traditional paper method for your workforce?YesNoUnsure - I would like more information about this option.b. Additional comments or questions regarding respirator medical clearance services:Respirator Fit TestingHow many total workers need a respirator fit test?Will all workers receive a fit test on the same mask style?YesNoWhich respirator(s) are used by your workforce?MakeModelTypeMakeModelTypeMakeModelTypeComment section to discuss respirators.What are the shift(s) of the workers needing a respirator fit test?Will your company supply the respirators for fit testing OR do you need Eagle Onsite to source/provide the respirators for fit testing?Additional comments or questions regarding on-site respirator fit testing services:Physical ExamsPlease select the physical exam(s) needed:Respirable Crystalline Silica Exams [29 CFR 1926.1153]Commercial Motor Vehicle “DOT” Driver Exams [FMCSA 49 CFR 391.41]Fire Department Firefighter Exams [NFPA 1582]HazMat/HAZWOPER & Emergency Response Team Exams [29 CFR 1910.120]Fire Brigade Exams [29 CFR 1910.156]Asbestos Exams [29 CFR 1910.1001]Benzene Exams [29 CFR 1910.1028]Chromium (VI), Hexavalent [29 CFR 1910.126]Formaldehyde Exams [29 CFR 1910.1048]OtherWhat are the shift(s) of the workers needing physical exams?Additional comments or questions regarding on-site physical exam services:Professional Supervisor ServicesI am interested in discussing case management, recordability, reportability, or work-relatedness hearing loss cases with an Eagle Onsite Board Certified Occupational Medical Physician or Audiologist.YesNoI am interested in more information regarding an Eagle Onsite Board Certified Occupational Medical Physician consulting on OSHA Regulatory Compliance, Medical Surveillance Programs, and/or Corporate Medical Director services.YesNoAdditional comments or questions regarding Professional Supervisor Services:Request QuotePlease do not fill in this field.