Please note the maximum you can request is four resources for a loan period of three weeks. Public Health resource booking form This form will take approximately 5 minutes to complete. Your data privacy Before completing this form please read our general Privacy Policy (opens in a new window). This explains why we ask for your data, what we do with it and how long we will keep it. It also explains how you can find out what data we hold about you and how you can ask us to delete it. Title Select your title. Mr Mrs Miss Ms Mx Dr Other Other Enter your title if it is not listed above. First name * Enter your first name. Last name * Enter your last name. Job title Enter your job title. Workplace address * Enter your workplace address. Email address * Enter an email address where we can write to you. Phone number * Enter a daytime phone number that we can ring you on. This can be a mobile or land line number. Order details First Item - Code and title Enter the item code and title. First Item - Date needed Enter the date when the item is needed. First Item - Length of the loan Enter how long you would like to borrow the item for. Do you want to add a second item? Select 'Yes' or 'No' as your answer. Yes No Second item - Code and title Enter the item code and title. Second item - Date needed Enter the date when the item is needed. Second item - Length of the loan Enter how long you would like to borrow the item for. Do you want to add a third item? Select 'Yes' or 'No' as your answer. Yes No Third item - Code and title Enter the item code and title. Third item - Date needed Enter the date when the item is needed. Third item - Length of the loan Enter how long you would like to borrow the item for. Do you want to add a fourth item? Select 'Yes' or 'No' as your answer. Yes No Fourth item - Code and title Enter the item code and title. Fourth item - Date needed Enter the date when the item is needed. Fourth item - Length of the loan Enter how long you would like to borrow the item for. Additional information Enter any additional order requirements.
