Please complete all fields marked * before submitting this form.

Please note that the contents of this form will not be encrypted upon submission. If you would prefer not to use this form to submit your information, please contact the Graphic Design Team.

Telephone: 0121 204 1514 / 1516 (internal: 51014 / 51016)
Email: Graphics@uhb.nhs.uk

Your name

Payment details

Your details

If you are a member of staff at University Hospitals Birmingham NHS Foundation Trust, please enter your specialty or directorate below.

If you are not a member of staff at University Hospitals Birmingham NHS Foundation Trust, please enter the name of your organisation below.

Delivery and collection

Please enter a delivery address below. If you are a member of UHB staff, please enter a collection point (Selly Oak Hospital or Queen Elizabeth Hospital Birmingham).

Contact details

Order details

Attach files

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We can't currently accept files totalling more than 500 KB in size via this form. If the total size of your files exceeds this limit, please email your files to us at the address below.

You can still use this form to submit the rest of your information.

Please note, you must not submit files containing the following using this form:

• Patient identifiable information
• Clinical photographs

Files containing this material may only be emailed to the Graphic Design team from a secure NHS email address (i.e. ending in ".nhs.uk" or "nhs.net") or supplied an alternative secure format.

Email: Graphics@uhb.nhs.uk

Job approval

Additional information