If you would like to transfer a television please provide the following information.
All efforts will be made to transfer the requested television within 1 hour during the hours of 8am - 8pm Eastern Standard Time.
Please note that the patients previous television will be switched off simultaneously when the new television is switched on.



Previous Location - TV to be turned off
Hospital Name *:
Ward*:
Bed Number*:
 
New Location - TV to be turned on
Hospital Name *:
Ward*:
Bed Number*:
Patients Name*:
 
Other Instructions
Please enter any additional instructions here:
   
 

 



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