1400 Eastside Road, Platteville, WI 53818
(608) 348-2331
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608.348.2331
Search
Find A Doctor
Search Providers
Southwest Health Clinics
View All Providers
About
Awards & Recognitions
Board of Directors
Community Health Needs
Connecting for Healthier Communities
History
Leadership Team
Nondiscrimination Statement
Patient Financial Services
Quality and Pricing
Vision and Values
Visiting Southwest Health
Our Services
Audiology
Birth Center
Cancer Care
COVID19 UPDATES & INFO
Dermatology
Diabetes Education
The EDGE
Emergency & Urgent Care
Emergency Medical Services (EMS)
Eye Center
Financial Assistance
General Surgery
Health Information
Laboratory
Mammography
Massage Therapy
Medical Imaging
Mental Health
Nutrition Services
Orthopedic Institute
Otolaryngology / ENT
Pain Management
Patient Financial Services
Pediatrics
Pharmacy
Pregnancy
Primary Care
Rehabilitation & Therapy
Senior Care
Sexual Assault Support
Sleep Lab
Specialty Clinics
Speech Therapy
Swing Bed Program
Women’s Center
My Healthy Life
Activity
Cancer Support Group
Class Schedules
COVID19 UPDATES & INFO
The COVID Vaccine
Depression Screen for Adults
Food & Eating
Know Your Numbers
Life Apart. Healthy Together.
Minds
Preventive
Programs & Events
Say It Out Loud! Art Contest
Sole Mates Walking Club
Work
Young at Heart
Media
Advertising
Community Engagement
Gallery of Gratitude
Heart 2 Heart Magazine
News
Social Media
Sponsorships & Donations
Videos
Giving
About the Foundation
Donate Online
Employees That Care (ETC)
Golf Outing
Moments of Impact
Scholarships
Volunteer
Ways to Give
Careers
Apply Online
Career Opportunities
Physicians
Student Experiences
Survey
Forms
Appointments
Blog
Baby Gallery
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Event & Evaluation Request Form
Event & Evaluation Request Form
Event Evaluation & Request Form
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1
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2
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Name of event
*
Date of Event
*
MM slash DD slash YYYY
Time of Event
*
:
Hours
Minutes
AM
PM
AM/PM
Description (purpose) of the event
*
Event Requested By
*
Target participants
*
Intention/Goal of Event
*
Type of Events
Please review the following four event categories and select which one your requested event falls under. This helps determine who will be assisting you in your efforts.
Internal Educational Event
Coordinate staff education (except for LDIs/TNTs which fall to Journey Teams).
Community Outreach
Events partnering or connecting with business, community leaders, external educational needs for businesses or employee groups.
Public Event
An event with a primary focus around public relations and patient/community recruitment to Southwest Health services.
Private Event
Events for community members to utilize Southwest Health resources like conference rooms or technology.
Select Your Type of Event
Event Type
*
Internal Education
Community Outreach
Public Event
Private Event