Health Fair/Event Participation Request Form

The University of Tennessee Health Science Center participates in numerous community health fairs throughout Shelby County. By partnering with local organizations, we aspire to raise health awareness and promote access to healthcare in our community.

Please provide at least 2 months advance notice. After completing this request on line, we will acknowledge your request within one week of our receipt.

Our participation and services provided will be based on the availability of our enrolled students, staff and resources. We will contact you to confirm or decline our participation no later than one month before your event date.

Event Information

Event Date (mm-dd-yyyy): Start Time: End Time:

Location Name:

Address:  Zip Code:

Event/Agency/Organization Host Name:

Target Audience: (ages, language, at-risk population, etc.)

Estimate Number of Expected Attendees:

Services Required:
Cholesterol Screenings [you must provide strips & machines] Blood Pressure Screenings
Glucose Screenings [you must provide strips & machines] Body Mass Index Health Education

Contact Information

Contact Name:

Contact Phone Number: Fax Phone Number:

Contact Email:

Any Additional Information:

Additional Information

If we cannot attend your event, we are able to provide information about UTHSC services: TARGET, etc.

If we are not able to attend, would you like us to send you this information?

If YES, please indicate language requested:

For questions or more information, please feel free to contact the UTHSC Health Fair Coordinator at 901-448-5618 or via email at

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