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.

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