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UCI Susan Samueli Integrative Health Institute Wellbeing Initiative – Service Request Form

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UCI Susan Samueli Integrative Health Institute Program & Service Request Form
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Please complete all sections and fields of this service request form. Please note that submitting this form does not serve as confirmation of your request. Requests should be made at least 2 months in advance. Once received, our team will contact you within 14 business days.

 Should you instead be requesting to utilize the Mussallem Nutritional Education Center (NEC), please complete this request form.

Should you instead be requesting to utilize the Palmer Family Research and Conference Room, please complete this request form.

Should you instead be requesting to utilize the podcast room, please complete this request form.
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Please confirm you have reviewed the Service Request details before proceeding 
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