Back To Main Page
Pager Request Form
Telepage / Communication Center
Note: Please wait for a reply email. Stating your request has been fulfilled.
What would you like us to do?
What do you want to do?
Create a new listing Using a Pager
Create a new listing Using Text messages to your Cell Phone
Create a new listing and Register the Spok App to your mobile phone
Create a new listing with a pager AND a cell phone
Change an existing Listing detail, like a name change
Choose SOMETHING from the pull down list above, so we know your request!!
Requestor's Information
Authorization:
Who is the person authorizing this device to be issued…
Requestor Name:
Your Name
Your Lawson Code:
REQUIRED!
:
No Lawson? Then no pager or Spok App. We need # for leasing
Requestor's Email:
Your Email
Required
Page Holder's Information
Page Holder Last Name/function
Function is the name of the listing if not a person
Page Holder First Name, MI:
,
Page Holder's Dept/Div Name:
Include sub-specialty
Ex: Medicine/Gastroenterology or Surg/Vascular Surgery
Holder's office Phone#
(Published)
Title:
Location:
Building Name?
700 BUILDING
AMBULATORY CARE CENTER
BIO TECH
CHILDREN'S PAVILION
CLINICAL SUPPORT CENTER
CRITICAL CARE HOSPITAL
EGYPTIAN BUILDING
GATEWAY BUILDING
HAYES E. WILLIS HEALTH CENTER
LYONS DENTAL BUILDING
MAIN HOSPITAL
MASSEY CANCER CENTER
MCGUIRE HALL & ANNEX
MCGUIRE VA MEDICAL CENTER
METROPOLITAN MEDICAL BUILDING
MOLECULAR MEDICAL RESEARCH BUILDING
NELSON CLINIC
NORTH HOSPITAL
NOW CENTER
OLD CITY HALL
ONE CAPITAL SQUARE BUILDING
ONE FRANKLIN SQUARE
RICHMOND MEDICAL COMMONS
SANGER HALL
SPORTS MEDICINE CENTER
ST MARY'S HOSPITAL
STEPHEN PUTNEY HOUSE
STONY POINT MEDICAL PARK
TECHNOLOGY SERVICES BUILDING
VIRGINIA TREATMENT CENTER
VMI BUILDING (MECHANICS INSTITUTE)
WEST HOSPITAL
WOOD MEMORIAL BUILDING
ZEIGLER HOUSE
Floor/Room #
Update info only
4 # pager ID:
Pager#:
When requesting phone messaging, select either [Spok Mobile Application] or [basic text message] for us to setup..
Requested message method ?
Select message delivery method...
Spok Mobile Application
basic text messages (not HIPAA Compliant!!!)
Messaging Device Information (Cellular Phone texting or Spok App 2 way texting)
Fill in, depending on your request
Spok Mobile Application?
Basic text messages
Not HIPAA Compliant!!
Holder's Cell #
yes
yes
Service Provider?
Service Provider?
Verizon
T-Mobile
AT&T
Sprint
Yes
Yes
type?
Mobile phone Type
iPhone
Android
Yes
No
Holder's Mobile email:
Yes
No
Notes or special instructions to assist with your request.
Notes -
Special
Instructions
(If making a change and adding messaging to a cell phone -
Please Specify which you are wanting to add Spok Mobile OR Basic Text Messaging)
Send Information to Update the Pager Director Listing