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Surgical Skills Lab


Forms and Documents

Orthopaedics Department

Contact Information
Robert Ullery, MS, ATC
Orthopaedics/Sports Medicine
Phone: 859-218-3061
Fax: 859-257-8696

Documents marked (PDF)
are in Adobe Acrobat format.
If you don't already have
Acrobat Reader installed,
you can download it here.
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Lab Request Form       Before you fill in this form, please print and read the Rental Agreement.

Event Sponsor:

Event/Function Title:

Please enter a contact e-mail:

Event Description/Details:

Choices of Date(s) for the Event:

Anticipated number of attendees/participants:

Lab rental amount requested
Full lab (5 stations + 1 Instructor's station)
Half lab (up to 3 stations)
Per station:
Number of Stations desired IF you selected "Per Station" Above:
1     2     3     4     5

Lab rental time reqested
Full day
Half day

Equipment/supply requests of items desired to be provided:

(We provide soft tissue, basic shoulder/hand/elbow/knee sets.)

If you are requesting specimens, you MUST fill out the Specimen Request Letter.


Items for event that will be provided/brought/shipped ahead of time or delivered by the event sponsor:


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Page last updated Thursday, February 04, 2010