2018 Health Fair Site Draw - Registration for Essendant Only

Health Fair




2/26/2018, 6:00 AM - 9:30 AM




The undersigned hereby requests that health screening examinations/tests be performed for me by HSHS Holy Family Hospital Health Fair personnel.

I understand that:
  1. A licensed health care provider will review all results and participants with critical results will be notified
  2. My results do not constitute a medical diagnosis.
  3. HFG will be unable to bill my insurance company and my insurance company may not provide reimbursement for this service.
  4. Any follow-up needed based on my results are my responsibility and not the responsibility of any participating organization.
  5. In accordance with HSHS Holy Family’s policies and federal regulations (HIPAA), patient information and test results are considered “protected health information” and will remain confidential. Click Here to view the Notice of Privacy Practices.
  By checking this box, I acknowledge that I have read and understand the above.

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