Request a Health Screening Event Request a Department Health Screening First name * Last name * Email * Department * Event Date Screenings require at least 8 weeks lead time. Please provide your top choices that are at least 8 weeks out. First choice * Second choice * Third choice Preferred time of day (check all that apply) * Morning Mid-day Afternoon OtherOther Note: The room needs to be available 90 minutes prior to screening start time and 60 minutes after screening end time. For reference, screening events run 3 to 4 hours. Estimated number of participants * Event Location The room will require tables and chairs. More information and layout guidelines. Building name and room number * Building address Additional notes or questions regarding your event (optional) Toolkit For help in planning your event, reference our Host a Screening Toolkit. reCAPTCHA If you are human, leave this field blank.