One Goal. One Passion. Every Patient. Every Time.
University Hospital

University Hospital Mail Services

SPECIAL DELIVERY REQUEST FORM

 

PLEASE COMPLETE AND SUBMIT FORM BELOW.

Your Information:

Today's Date:

   

Your First Name:

Your Last Name:

 Your E-mail:
(Required for Confirmation)

Your Telephone #:

Department Name:

Index #:

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Transportation Information:

Pick up Date:

Insert # of Parcels:

Indicate Boxes, Letters, Specimens, Non-medical Supplies etc.:

Pick up Contact Name and Tel. # (if different from above)

Parcel(s) Departing From:
(Department, Campus,
Room #)

Going to:
(Department, Campus,
Room #)

     

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Additional Information:
Hand Delivery, Signature Required, Urgent Delivery, Etc.: