Patient Visitor Hotel Accommodations Program: Reservation Request


If you require same day reservations please contact Patient & Visitor Accommodations directly at 1-800-544-8684.  This e-mail is staffed Monday – Friday 9am-5pm.

Please complete as much information as possible to assist in preliminary searches.

All reservations are made after personal contact with guests. Confirmations are provided for all confirmed arrangements.

* Required fields

*First Name:
*Last Name:
*Home Address:
City :     State :    Zip Code:
*Phone Number :
Expected Arrival Date:
Expected Departure Date:
Number of Beds Needed:
Number of Rooms Needed:
If Med Inn rooms are not available, is shuttle service absolutely required?  
Is Med Inn your first choice?  
Other First Choice: Specific Hotel Request if known:
Second choice if known:
Most desired type of hotel:
Highest priority for decision when the Med Inn is not available:

Geographic location if a primary issue:
Are you in need of financial assistance for your lodging expenses?   
Other Comments :
Destination Program: (Internal Use Only)

Patient Facilitated Services (PFS)