Health Fair Request - Cabell-Huntington Health Department

Health Fair Request

To request our presence at your community event, please fill out the following form.

Contact Information:

Agency

Contact Name

Contact Phone Number

Contact Email

Event Information:

Event Title

Event Focus

Event Date:

Start Time

End Time

Set Up Time

Event Location

Facilities Information:

Tables/Chairs Provided Canopy Provided (if outdoors) Electricity Access Running water available

Other Information

Which services should we include? (Select boxes for educational material requested)

Clinical Services

Family Planning Sexually Transmitted Diseases Immunization Education Harm Reduction Program

Health and Wellness

Diabetes Healthy Lifestyles Tobacco Blood Pressure Check

Thread Preparedness

Emergency Preparedness Medical Reserve Corps (Volunteer program) Fire Safety

Special Requests:

Accreditation

Annual Reports

Leadership Team

Board of Health

Location

Code & Regulation Links

Account Login