Service Request Form

Service Request

A service request is a request for information, advice, a change, addition or for a standard change (a pre-approved change that is low risk, relatively common and follows a procedure)
Project
First Name*
Last Name*
Name*

First NameLast Name
E-mail*
firstname.surname@birminghamhospice.org.uk
Phone Number:*
Please enter a valid phone number - include area code.
Which department do you belong to?
Example: IPU, H&H, PHB, People Team
Which Department are you located at?*
1st Line of your address:
House/ Apt Number and Street Name
City:
Which City is this?
Post Code:
Whats the postcode
What type of request do you want?:*

Information Or AdviceInstallationMove Add or ChangeTraining & Support
Category
And what service or product would the request apply to :*

Application (Install)Change personal details (Job Title, Work Hours, Display Name)Email - Access to additonal inboxEmail - Request new email accountEquipment MoveMeeting Room EquipmentSharepoint (Permissions)Teams - NumberTeams - ChannelTraining
Does your request apply to:

An individualA Department
Risk rate your request:

No risk to Hospice reputation, doesn’t contravene any legal obligations and will not result in financial loss to the company.Moderate risk to Hospice reputation, doesn’t contravene any legal obligations or may result in some low financial loss to the company.Likely to cause reputational harm, contravenes our legal obligations, or highly likely to cause large financial loss to the company
Main Issue
Provide further details:*
Where will you be located for the appointment time?*
Please note we dont offer remote support and have to come on site to fix issues.
What is your preferred availability

We will try and match your availability where possible.
Erdington*
Selly Park*
Service Level Agreement
Suggested Datetime Erdington
Suggested Datetime Selly Park
Should be Empty:

Service Request

What is your preferred availability