BHC - Outreach Request Form

To ensure our availability, we ask that this form be completed at least 2 weeks before desired date. Request made with less than 2 weeks’ notice may not be able to be accommodated. Submitted request will be reviewed by the BHS staff who will then contact you by phone or e-mail to confirm your request. If you do not hear from us within 48-72 hours, you may reach out to us at 301.687.4310 or bradyhealth@frostburg.edu. This form is not for scheduling patient appointments, if you would like an appointment please call our office at 301.687.4310 or utilize online scheduling through the Patient Portal.

Your Name

Department/Organization

Email Address

Phone

Perspective Audiences

Other Audiences

Type of Request

Tabling – Informal way of greeting, engaging, and providing information about BHC and our services.Presentation – Presenting information about a specific health service topic to an audience.

Name of Event

Topic Requested