District 47 – Wellness Screening Registration Form

district47

***This form works best with Google Chrome***
Bernotas screening is on:

Wed 03-20-2024 6AM-9AM

Canterbury screening is on:

Tue 03-05-2024 6:30AM–9AM

CORE Center screening is on:

Fri 03-01-2024 7AM-9AM

Coventry screening is on:

Fri 03-22-2024 6:30AM-9AM

Glacier Ridge screening is on:

Wed 03-06-2024 6:30AM-9AM

Hannah Beardsley screening is on:

Mon 03-04-2024 6AM–8:30AM

Husmann screening is on:

Fri 03-08-2024 6:30AM–9AM

Indian Prairie screening is on:

Tue 03-19-2024 6:30AM–9AM

Lundahl screening is on:

Thu 03-14-2024 6AM–8:30AM

North screening is on:

Thu 03-07-2024 6:30AM–9AM

South screening is on:

Mon 03-11-2024 6:30AM–9AM

West screening is on:

Thu 03-21-2024 6:30AM–9AM

Woods Creek screening is on:

Tue 03-12-2024 6:30AM-9AM

Legal First
Legal Last
Your insurance status will be validated before the screening.

Tests Requested

Please check each additional test below you would like to add to your basic screening
Note: Basic screening includes: CMP, CBC, & Lipid Panel
Note: Additional lab tests may also be added or changed, the day of your screening

All screenings include, height, weight, blood pressure, and body composition analysis

Click here for lab test explanations

Do you have any of the following?
Total charges: $
Total pre-paid charges: $
After payment, please click 'Return to Community Health Works' to schedule an appointment

Please remember to fast for 8 hours. Black coffee, water, and plain tea are allowed.
Once you click submit please wait for the appointment scheduling form to appear...

Designed by: X-Tek Web Solutions