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Community Health Screening Consent Form - Free Nonprofit Template | ZenBuild | ZenBuild

Templates→Nonprofit→Community Health Screening Consent Form

Community Health Screening Consent Form

Collect participant consent and basic health information before a free community health screening event.

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Community Health Screening Consent Form

Collect participant consent and basic health information before a free community health screening event.

Participant Full Name*

Email Address

Phone Number

Date of Birth*

Primary Language

Screenings You Wish to Receive*

Blood pressureBlood glucoseCholesterolBMI/weightVisionDental checkMental health screening

Do you currently have a primary care provider?*

YesNo

I consent to the following*

Voluntary participationUse of anonymized data for reportingContact for follow-up resources

Health Conditions or Medications to Note

Template Details

CategoryNonprofit

Fields9

Uses0

Views1

health screeningconsentcommunity healthevent