Maintenance Request Form

Name

Extension

E-Mail

Select BuildingHospitalMora ClinicPC ClinicHinckley ClinicEye ClinicRetail Pharmacy

Room Number or Nearest One

Choose ServiceDoorsElectricalFire & SafetyFurnitureGeneral RepairsHeating/Air ConditioningKey/Card AccessLight Bulbs/LightingPlumbing

Other:

In case of emergency, please call ext. 3477 or 612-654-6121.

Priority:

Select Priority LevelLowStandardHigh