Service Request Form for Healthcare & Allied Health

# Service Request Form - Healthcare & Allied Health

## Purpose
Implement to replace ad-hoc email and phone requests with a structured intake process that improves tracking and accountability.

## When to Use
A service request form for clients or internal teams to log work requests with priority, description, deadline, and attachment capabilities.

## Instructions
1. Review the template below and familiarise yourself with the structure
2. Replace all [bracketed placeholders] with your healthcare & allied health business details
3. Customise the tone and formatting to match your brand
4. Save in your preferred tool (Asana or Zapier)

---

## Service Request Form

**Purpose:** Replace ad-hoc emails and phone calls with a structured request intake process that improves tracking, prioritisation, and accountability.

### Section 1: Requester Details
| Field | Type | Required | Validation | Placeholder |
|-------|------|----------|------------|-------------|
| Your Name | Text | Yes | Min 2 characters | Jane Smith |
| Email Address | Email | Yes | Valid email format | jane@company.com.au |
| Phone Number | Phone | No | Australian format | 04XX XXX XXX |
| Department / Team | Dropdown | Yes | - | Marketing / Sales / Operations / Finance / HR / IT / Other |
| Company Name (for external requests) | Text | No | - | Acme Pty Ltd |

### Section 2: Request Details
| Field | Type | Required | Validation | Placeholder |
|-------|------|----------|------------|-------------|
| Request Title | Text | Yes | Min 5 characters, Max 100 | Brief summary of your request |
| Service Category | Dropdown | Yes | - | [Customise: Design / Development / Content / Reporting / Technical Support / General] |
| Priority Level | Radio | Yes | - | Low (nice to have) / Medium (needed this month) / High (needed this week) / Urgent (needed today) |
| Detailed Description | Textarea | Yes | Min 30 characters, Max 2000 | Describe what you need, including any relevant context, specifications, or examples... |
| Desired Completion Date | Date | Yes | Must be at least 2 business days from today | DD/MM/YYYY |

### Section 3: Supporting Information
| Field | Type | Required | Validation | Placeholder |
|-------|------|----------|------------|-------------|
| Is this related to an existing project? | Radio | Yes | - | Yes / No |
| If yes, which project? | Text | No | - | Project name or reference number |
| Attachments | File Upload | No | Max 3 files, 10MB each, PDF/PNG/JPG/DOCX | Upload reference files, briefs, or examples |
| Link to related documents or resources | URL | No | Valid URL | https://... |

### Section 4: Approval
| Field | Type | Required | Validation | Placeholder |
|-------|------|----------|------------|-------------|
| Approving Manager | Text | No | - | Manager name |
| Budget Code or Cost Centre (if applicable) | Text | No | - | e.g., MKT-2026-Q1 |

### Conditional Logic
- If "Priority Level" = "Urgent", show note: "Urgent requests are subject to availability. A team member will contact you within 2 hours to discuss."
- If "Is this related to an existing project?" = "Yes", show "If yes, which project?" field
- If "Priority Level" = "High" or "Urgent", trigger immediate Slack notification to team lead

### Submission
- **Button text:** "Submit Request"
- **Confirmation message:** "Your service request has been submitted. You will receive a confirmation email with your request reference number. Expected response time: [Based on priority level]."
- **Notification:** Create task in project management tool, send Slack notification to assigned team, email confirmation to requester with reference number

---

**Complexity:** simple | **Setup time:** 10 minutes | **Tools:** Asana, Zapier, Slack

Note: This template has been tailored for healthcare & allied health businesses in Australia. Adjust terminology and compliance references to match your specific context.