Contact Us Address: 1079 South Ancona Avenue Suite 100 Eagle, ID 83616Phone: 208-853-2273Fax: 208-376-3831Email: firstname.lastname@example.org Patient Portal Login Schedule A Call With Our Client Services Team Information About Our Services Intake Form Name of Organization* Contact Name* First Last Contact Title/Role* Contact Phone*Contact Email* Organization Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Reason for Contacting Us? Schedule an on-site Health Screening and/or Flu vaccine clinic at your workplace COVID-19 Services (Vaccine, Antibody Testing, COVID PCR Testing) Schedule a lab draw at our Eagle office Other Number of Employees that you anticipate being interested in participating in a health screening and/or vaccine clinic at your location? 10–25 25–50 51–100 More than 100 To verify benefits, please provide Companies Insurance Carrier.Name of InsuranceSubscriber NumberDate of BirthGroup Number (Optional)Have multiple insurances? Please click the following that apply. Blue Cross of Idaho Blue Cross Blue Shield Regence Select Health Pacific Source Other Are there any upcoming dates or time frame that would work well for a health screening/vaccine clinic? Any other reasons?