Community Health Event Request Form

Community Health Event Request Form

Please complete the form below to request services from the Florida Department of Health in Miami-Dade County (DOH-Miami-Dade). We recommend that you complete this form 30 to 60 days prior to an event.

DOH-Miami-Dade has a variety of individual programs and services available. Each program is responsible for confirming their own availability and services. If a program is available to attend your event, they will reach out to you directly. If no response is received, the selected program(s) may be unavailable to attend.

Need help filling out the CHER form? Click here to watch a video tutorial.

    Event Details


    As a state-agency, FDOH-MD provides in-kind services and may be unable to pay associated event fees.

    Please check at least one item
    IndoorOutdoorRain ShelterBathroomsPrivate Area for Confidential ScreeningElectricityAV EquipmentRefrigeration (for Vaccines, Test Supplies)

    If yes is selected, event details and planner contact information will be available for public viewing.

    Please check at least one item
    FlyersRadio/TV SpotsNewspaper AnnouncementsSocial MediaWebsiteN/A

    General PublicCollege & UniversitySenior GroupsK-12 StudentsHealth ProfessionalsFaith-basedChildren & FamilyEmployeesOther

    EnglishSpanishHaitian CreoleOther


    Services Requested

    Breast & Cervical Cancer, Family Planning, and Dental Health (Preventive Services)Breastfeeding/Nutrition education for pregnant women, infants, and children (WIC)Chronic Disease & Prevention (includes blood pressure, cholesterol, diabetes, nutrition, & physical activity)Condoms/Safer Sex MaterialsConsortium for a Healthier Miami-DadeEpidemiology Program (communicable diseases, Healthy Home: lead poisoning & asthma)Environmental Health (drinking water, beach monitoring, swimming pool safety, septic systems, tattooing, body piercing, tanning, residential facilities, schools, migrant housing, mobile home parks)Florida KidCare (request will be forwarded to this partner agency)Healthy Start Coalition of Miami-Dade (request will be forwarded to this partner agency)Hepatitis ProgramPublic Health Preparedness and ResponseSTD/HIV ProgramTobacco Prevention and ControlTuberculosis Control & PreventionN/A

    American Diabetes Association Type 2 Diabetes Risk assessmentBlood PressureBody Mass Index/Body Fat AnalysisSyphilis, Chlamydia, Gonorrhea, Hepatitis C, and Pregnancy Testing (STD/HIV Program)Free In-Home HIV Test (STD/HIV Program)N/A


    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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