Speci Logistics

Pickup Request

Schedule a Medical Courier Pickup

Give dispatch the facility, timing, shipment, handling, and proof requirements needed to review a real pickup request.

Chain-of-custody workflow with documented handoff process

Become a Client Schedule Pickup Get Pricing Instead Contact Dispatch

Creates a queued operational job for dispatch review
Links to an existing client organization when names match
Captures facility contacts, timing, material category, temperature, access, and proof requirements
Designed for real pickup requests, not just quote leads

Fields marked with * are required. Do not enter patient names, dates of birth, medical record numbers, test results, or other PHI.

Organization and requester

Organization / Facility Name *Organization Type *DepartmentContact Name *Title / RolePhone *Email *Preferred Contact MethodPO / Account Reference

Service and timing

Service Type *Priority *Requested Pickup Date & Time *Required Delivery Date & TimeService Frequency *Estimated Monthly VolumeThis request may require after-hours coordination.

Pickup location

Facility / Location Name *Suite / Floor / DepartmentStreet Address *City *

State *ZIP *

On-Site ContactOn-Site PhonePickup Instructions

Delivery location

Facility / Location Name *Suite / Floor / DepartmentStreet Address *City *

State *ZIP *

Recipient / Receiving ContactRecipient PhoneDelivery Instructions

Shipment and handling

Material Category *Package Count *Shipment Description *Approximate Size / WeightTemperature Requirement *Temperature NotesPackaging *Regulated Hazardous Material? *

Custody and proof requirements

Documented chain of custodyRecipient signaturePhoto proof of delivery

Access / Security Requirements

Service planning

Relationship InterestCurrent Coverage Need or Pain PointAdditional Instructions

Authorization

I confirm that I have not included PHI in this form. I understand this submission is a request for dispatch review, not confirmation that a courier has been assigned.