Health Fair Visitor Check-in Form
Please complete this form to check in and participate in the health fair. Your information helps us provide a safe and valuable experience.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Age
*
Gender
Male
Female
Non-binary
Prefer not to say
Other
Have you attended a health fair before?
Yes
No
Which health services are you interested in today? (Select all that apply)
*
Blood Pressure Screening
Blood Glucose Testing
Vision Screening
Hearing Screening
Nutrition Counseling
Fitness Assessment
Mental Health Resources
Other
Do you have any allergies or medical conditions we should be aware of?
Emergency Contact Name
*
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
How did you hear about this health fair?
Please Select
Social Media
Flyer/Poster
Word of Mouth
Community Organization
Other
Check In
Should be Empty: