To request a Rate Sheet or book a medic, please complete the form below. Fields with * are required. We will reply to all booking requests within 12-24 hours.   If your request is within 24 hours please call (844) Set-Medic (844 738-6334) for immediate assistance.

Order Number

Your Name *

Phone Number *

Location Address (If you have it)

Production / Event Name *

Report to City *

E-Mail *

Report to State *

- Select Province/State - Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon ==================== Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Billing Name and Address

How did you hear of us?

Referral LA 411 Production Hub Internet Search

Report to Zip Code *

Requested Date(s) *

Estimated Call Time *

Estimated Number of Hours *

10 hour Min 12 Hour Min 12+ Hours

Details / Message

We understand how sensitive your production details are.  You can feel safe reaching out to us.  Greater detail allows us to better serve you!

The National Set Medic Guarantee: The information you provide will remain confidential.  None of the information you provide will be shared with anyone outside our organization.