Health Fair Request

A stethoscope and a fountain pen on top of a medical form

We are devoted to helping keep our communities healthy and informed. If you are having a health fair, and would like materials or a representative for an event, please complete the form below for your request to be considered. If you have not received a response to your request within 72 hours, please call 713.439.6246.

Requester Information
Enter Organization Name or Name of Even.
Please Enter the name of the Contact Person
Enter Event Date and Time
Open the calendar popup.
Enter the Event Address
Please enter your Phone number
Please enter your email address
Enter City
Select State from the List.
Please enter the event zip code

Please Check more then 1 box from the Type of Request.

Please Check more then 1 box from Target Audience.

Please Check more the 1 box from Language of Attendees.

Please select Number of Attendees from the list.

Please check 1 or more box from Requested NCDP Program.

Please Details and Special Instructions About Your Request Here.
Enter the code shown above in the box below.