● Complete this form to schedule a Health Fair. You will select programs and screenings below.
● A confirmation of this event will follow within 24 hours. Please call if it is not received.
● Call us directly at 631-842-1122 or Email us with any questions beforehand. Thanks!

Date and Hours Requested

 

Event Location Information

 

Billing Information

 

Select the Screenings and Programs to be Conducted

 

Agree to the Terms of Service

  • By checking the box below you are signing this document. Your request, when signed by Heart Screen, also confirms this event and reserves the date on Heart Screen’s calendar. A confirmation of this event will follow within 24 hours. Please call 631-842-1122 or Email us if it is not received.
 

Verification