This form is for PHC staff to order new and replacement nametags. Unfortunately we are not able to accept any abbreviations or Physician nametag orders. If you have any questions please email Howard Lau at
Please choose your title from the dropdown list. If it's not listed here, type it into the box below.
Choose whether you want a nametag with a pin back or a magnet back. (Staff on Mental Health units should have a magnet for safety reasons.)
*Work Site Information

There is a designated person on each unit who distributes the nametags. Please ask your Patient Care Manager, Clinical Nurse Leader  or Nurse Educator if you need to know where to pick it up.