subject_line
Maintenance Request
Phone: (248) 395-3777, Fax: (248) 395-3370,
www.hchs.com
,
28000 Woodward Ave., Royal Oak, MI 48067
First Name:
*
Last Name:
*
Email Address:
*
Date of Request:
*
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Note: Emergency requests include flooding and electrical and any other issues that pose immediate threats to safety and access.
Is this an urgent/emergency request?
*
Yes
No
Location:
*
Berkley - Clinic (28139 Woodward, Berkley)
Royal Oak - Clinic (28000 Woodward, Royal Oak)
Royal Oak Headquarters (28454 Woodward, Royal Oak)
Client Home
Address:
Issue (and specific location):
*
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