Community Health Outreach Program

HEALTH FAIR REQUEST FORM SURVEY

Instructions:
Please complete the form below. This form can be used to request services from the Miami Dade County Health Department solely, as well as from the Consortium for a Healthier Miami-Dade. Those interested in participating will contact you directly to discuss their availability.










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Target Audience


General PublicCollege & UniversitySenior GroupsK-12 StudentsHealth ProfessionalsFaith-basedFamilyCorporate SettingOther

EnglishSpanishCreoleOther

0-1819-2425-3536-5051-6970+


Requested Services


Miami Dade County Health Department OnlyHealth Dept and Consortium for a Healthier Miami Dade

ArthritisAsthmaBlood PressureBreast Cancer InfoBreastfeeding/WICCervical CancerCholesterolDentalDiabetes EducationDomestic ViolenceEnvironmental HealthFamily Planning InfoGlucose TestingHealthy StartHepatitis EducationHepatitis TestingHIV EducationHIV TestingKidCare InfoNutritionProstate CancerSafer Sex MaterialsSexual AssaultSTD EducationSTD TestingSickle CellTB EducationTobacco Cessation

CondomsSafer Sex MaterialsNeither


Site Accommodations for Health Providers (Vendors):
IndoorOutdoorRain ShelterBathroomsPrivate Area for Confidential ScreeningElectricityAV EquipmentRefrigeration (for Vaccines, Test Supplies)






Other Information:













DISCLAIMER:

DISCLAIMER:
The Florida Department of Health in Miami-Dade County and the Consortium for a Healthier Miami-Dade are NOT endorsing any activity by disseminating this form. The purpose of this form is only to disseminate information about community health fairs and provide a forum for collaboration and partnerships between interested organizations. It is NOT the responsibility of the Consortium to coordinate or determine if there is any sponsorship exclusivity related to each community health fair. Any questions regarding the event must be directed solely to the event planner.

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