PACS Outreach Service Request Form

We will attempt to honor your service request. However, due to availability of staff during the requested date(s)/time(s), we cannot guarantee every request. The likelihood of honoring your request is increased significantly if there are alternative days and times and if you submit the request at least two weeks in advance. 


We kindly ask that those requesting an outreach be responsible for arranging a location.
Preferred Date(s) and Time(s) of Service
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
2 + 9 =