CenterNet | Clinic Financial Services

Oklahoma State University
Center for Health Sciences

Scheduling Template Form

Submit one form per Mega West scheduling number
Allow 72 hours for completion
To expedite template changes/creation be as detailed as possible

	Change Existing Template
	New Template
		Effective Date:
	Temporary Change
		Start Date:
		End Date:

Department:

Requesting Physician:

Mega West Scheduling Number:

Please list time slots on appropriate days, including:

duration of appointment

appointment type

number of appointments per time slot

Monday

Tuesday

Wednesday

Thursday

Friday

Day

Appointment Time

Duration

Appointment Type

Quantity

Please explain any additional details below:

Digital Signature:	Date:

E-mail:	Phone Number:

You will be contacted via email when these templates have been completed.

If you have any questions, please email:

CFS.Scheduling.Templates@okstate.edu

Contact:
Rebecca Morgan (561-8387), rebecca.greene@okstate.edu
or
Shawna Wren (561-1161), (shawna.wren@okstate.edu)