Parking Registration - TEST - Regional One Health

Parking registration applies to internal Regional One Health staff, authorized vendors and service contractors only. Valet parking is available for patients and visitors at the main hospital entrance and the entrance of our Outpatient Center. For a complete list of available public parking, please use Google or Apple Maps.

Contact Information

First Name(Required)

Last Name(Required)

Campus Address(Required)

Room Number

Department Name(Required)

City(Required)

State(Required)

Postal Code(Required)

Campus Phone(Required)

Email Address(Required)

Permit Information

Type of Permit Requested(Required)

Reason for temp:(Required)

Reason for service/vendor:(Required)

Vehicle Information

Tag Number(Required)

Tag State(Required)

Make(Required)

Model(Required)

Color(Required)

Year(Required)

Signature(Required)

Comments

This field is for validation purposes and should be left unchanged.

Parking Registration – TEST

Contact Information

Permit Information

Vehicle Information