GET HEALTHY PASADENA REGISTRATION

Please fill out the form below to register for a FREE health screening at the 2011 Get Healthy Pasadena. All fields are required. Thank you!

Click here to download details about the Food and Entertainment at Get Healthy Pasadena!

Registration

Name:

Phone Number:

Email:

Female
Male

FREE Health Screening Selection
I am interested in the following screenings:

Prostate
Cholesterol
Dental
Diabetes
Eye Care/Vision
Hearing
High Blood Pressure
Body Mass Index (BMI)
Stroke (carotid artery)

What is your age group?

Age 30 – 39
Age 40 – 49
Age 50 – 59
Age 60 – 70+

Time of Arrival:

8:30 am – 10:30 am
10:30 am – 12:30 pm
1:30 pm – 3:30 pm