Patient: Please complete this section.
Registration Use Only: Please mark all tests required:
The undersigned hereby requests that health screening be performed for me by the organization and individuals participating in the Lab Work Specials under the direction of North Canyon Medical Center. I understand that all screenings will be performed without charge to me whatsoever, expect for the optional blood work.
I hereby release the major sponsors, organizations and individuals participating in the Health Fair from any and all liability including any matter or thing committed or omitted which may arise during blood drawing, vaccination, or other screening or from the data derived there from.
Health Fair test results will not be mailed out this year but will be available within 24 hours through the patient portal.
Billing & Payments