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:

 Requester Information
  * = required
Request Date:
*Requesting Organization:
*Requester Name:
Mailing Address:
*Phone:
Fax:
*Email:
 Event Information
*Event Name:
*Type of Event:
*Event Location: Name:
Address 1:
Address 2:
City:
State: Zip Code:
On-Site Contact Name:
On-Site Phone:
*Event Start:    at  :  
*Event End:    at  :  
Expected Attendance:
Target Audience:
(age, ethnicity, etc.)
Items Provided:
Other:
Request:
Additional Information
Comments/Additional Information:
 Submit Your Request


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