DOH-Sarasota masthead
Public Health Services Health Care Immunizations Environmental Health Community Programs
 
Health In Motion (Mobile Medical Unit)

Appearance Request

Please complete the following form to assist us in considering your request for Health In Motion (our Mobile Medical Unit) to be at your event. Please note the following:

  • Service not available on Sundays
  • Requests must be submitted with at least three months advance notice
  •  Our services are geared for adults
Type of event:
 Health Fair
Community Expo or Community Event
Worksite Event
Other

Name of event:

Who is expected to attend (target audience)?
 Families
Seniors
Women
Community (General)
Community Leaders
Health and Medical Professionals
Other: 
  
How many people do you expect to attend?
 Fewer than 50
50 to 100
100 to 150
More than 150
 
What health services are requested?  (Check all that apply.)
Blood pressure screening
Blood sugar testing - diabetes
HIV testing
Pregnancy testing
TB skin testing
Health education
Other service:
 
Will there be other providers at the event providing health services?
 YesNoUnsure
 
If yes, please describe:
 
Event Details
(No Sundays. Allow 3 months advance notice.)
  
Is there a sufficient parking area for Health In Motion?
HIM is a 40-foot bus requiring about five parking spots that can be reserved in advance of the event.
YesNoUnsure
 
If not, or if an indoor location is desired, can you supply a table with four chairs?
YesNo
 
 
Name of person making request: