Submit a request – UW Medicine

Your email address

First Name

Last Name

Phone / Extension

Ticket Subject

Request Type

URL / Web Page Address

Please Describe the Issue

Please enter the details of your request. A member of our support staff will respond as soon as possible.

Requested Date of Completion

Requested Date of Removal

Does this request expire? Is there a removal date? If so, please provide the date above.

Priority

PRIORITY OPTIONS: Low: Asap, but no rush | Normal: 3-day turnaround | High: Same day turnaround | Urgent: Within 2 hours

Attachments

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