COMPUTER SEARCH REQUEST FORM

Note: There is a charge for this service.

Name:

Date Requested: Date Needed:

Dept/Affiliation:     Select:

Phone:    Fax No.

UMC Charge Code:    E-Mail Address:

Other Method of Payment:

Invoice

Cash

For NON-UMC:

Mailing Address (must be completed for billing):

Please specify the databases/years you wish searched:
(Use the Control Key to select more than one database)

  Other

Years:

Please check if applicable:
LIMITS:
English Only:      All Languages:      OTHER (Specify):
 
ADDITIONAL LIMITS:
Animal:  or Human: or Both:
Male:  or Female: or Both:
 
LIMIT AGE GROUPS:
ALL AGE GROUPS: Infant, Newborn: Infant (1-23 Months):
Child, Preschool (2-5 yrs): Adolescence (12-18 yrs): Adult (19-44 yrs):
Middle Age (45-65 yrs): Aged (65+ yrs): Aged (80+ yrs):
 
PURPOSE OF SEARCH:
Direct Patient Care:      Research:
 
INSTRUCTIONS:
Print abstracts:     Pick up in Library     FAX to patron:    E-Mail to Patron

SUBJECT TO BE SEARCHED (PLEASE PUT IN SENTENCE FORM):