Community Event & Health Fair Request Form

Hartford Hospital partners with local organizations on health fairs and community events as part of our commitment to help improve the quality of life in our community by encouraging individuals to take charge of their health through education and awareness.

To request our participation in your organization's health fair or community event, please complete this form in its entirety. When a decision has been made to approve your request a representative will contact you to coordinate Hartford Hospital's participation. Please note all requests must be made at least six (6) weeks prior to the event.

Tell us about the event and the type of health screenings and health education/information you would like us to provide:

* = required field

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Requester Information:

Requesting Organization *

Requester Name *

Mailing Address

Phone *

Fax

Email *

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Event Information:

Event Name *

Type of Event *

Event Location Name *

Event Location Address *

On-Site Contact Name

On-Site Phone *

Event Start:

Date *

Time *

Event End:

Date *

Time *

Expected Attendance

Target Audience (age, ethnicity, etc.)

Items Provided

Table(s)
Chair(s)
Canopy/Tent
Other (listed below)

Other Items Provided

Services Requested

Screenings
Health Education Materials

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Additional Information:

Comments/Additional Information

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Submit Your Request:

Enter code shown below *

If after clicking 'Send' nothing appears to be happening, click here to see if any fields were entered incorrectly.

Community Outreach

Community Benefits Representative

Email: info@hhchealth.org

Community Event & Health Fair Request Form

Hartford Hospital partners with local organizations on health fairs and community events as part of our commitment to help improve the quality of life in our community by encouraging individuals to take charge of their health through education and awareness.

Tell us about the event and the type of health screenings and health education/information you would like us to provide:

Requester Information:

Event Information:

Additional Information:

Submit Your Request:

Community Outreach

Community Benefits Representative

Email: info@hhchealth.org

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