Song Request
If you know someone who is in hospital and has access to Radio Lollipop, you can request their favourite song be played by completing the simple form below. We will do our best to play it on the date you specify but we cannot guarantee. If you are not sure of the name of the song simply put a type of music instead.
Select the location of the hospital
*
Please Select
Armadale
Birmingham
Bristol
Christchurch
Dundee
Edinburgh
Evelina
Fiona Stanley
Glasgow
Gold Coast
GOSH
Holtz
Joondalup
Kalgoorlie
Kidz First
Logan
Manchester
Manukau
Mater
Midland
Monash
Murdoch
MUSC
New York
Newcastle
Nelson Mandela
Perth
Queensland Children's
Rockingham
Southampton
Starship
Texas
Waitakere
Whangarei
Patient's first name
*
Ward
*
Date to play request
-
Day
-
Month
Year
Date
First choice of song name
First choice artist's name
Second choice of song name
Second choice artist's name
Who is this song request from?
Any special message to include?
Submit
Should be Empty: