Type of event: Health
Fair Community
Expo or Community Event Worksite
Event Other
Name of event:
Who is expected to attend (target audience)? Families Seniors Women Community (General) Community Leaders Health and Medical Professionals Other:
How many people do you expect to attend? Fewer than 50 50 to 100 100 to 150 More than 150
What health services are requested? Blood pressure screening
Blood sugar testing - diabetes
HIV testing
Pregnancy testing
TB skin testing
Health education
Other service:
Yes No Unsure If yes, please
describe:
Event Details
Is there sufficient parking area for the 40-foot Health
In Motion mobile medical unit? Yes No Unsure
Yes No
Name of
person making request:
