This form is for clients of Secure Alliance PS including School Districts,
Adult Family Homes, and Local Businesses ONLY.
This is not the form for Western State Hospital. <-- Click here to access the correct form.
Welcome School Districts, Adult Family Homes, and Local Businesses.
This is your form to fill out for Fit Testing.
ALL SALES ARE FINAL - we have to pre-pay for your masks and the supplies for fit testing as well as pay the medical provider on your behalf for your evaluation. Completion of this form is evidence of agreement that you have or will pay for the evaluation fee. Your sale is final and not subject to refund. We do not provide refunds after delivery.
It is your responsibility to secure your mail.
NO EXCEPTIONS
It is your responsibility to secure your mail.
NO EXCEPTIONS