Company information

Contact name:
Company:
Address
Phone number:
Alternate phone:

Event details

Date:
Time:
Address:
Set up date:
Set up time:
Event frequency:	annualone-time
Health fair purpose:

Anticipated number of participants:

Health education
What information would you like to provide your employees? (check all that apply) cancer prevention and treatmentphysical therapy
hearing servicesspine and back care
heart healthweight management
nutritionother If other please specify:


Clinical screenings
Note: These services are available at a rate of $30/hr per person, including travel time.
blood pressure screening
BMI - body mass index
height/weight
glucose (additional charge for glucose strips)
total cholesterol screening (additional charge for cholesterol strips)
waist measurement (determine heart disease risk)