CAHN: Capital Area Health Network: Dental Care

We accept all patients... uninsured and insured! We also accept Medicaid and Medicare patients. All patients are treated with dignity and respect.

CAHN Health Fair Request Form For Your Community Event
Click here for a print version of this form.

Date

Request received by

phone

mail

other

Initial request received by

Forwarded to

Date

Program

Name of Organization

Contact Name

Mailing Address

City

State

Zip

Phone

Fax

E-mail

Date of Event

Time

Event/Activity Name

Description of activities

Purpose/audience served

Age Ranges

Expected attendance (numbers)

Other participating agencies

CAHN Services Requested

Location of event/activity:
Street address

City

State

Zip

*Setup (indoor/outdoor)

indoor

outdoor

Check appropriate box

CAHN will participate

CAHN will not participate

Reasons for not participating

GUIDELINES FOR RESPONDING TO REQUESTS FOR HEALTHFAIR/EVENT PARTICIPATION

Use health fair request screening criteria to determine if CAHN participation should be considered.
A decision on CAHN participation should be made within 24 hours.
The requesting party should be responded to within 48 hours after a healthfair/event request has been received.
Individual program participation must be approved by the program manager.
Activities that will involve multiple programs must be approved by the Marketing Manager.

If you have any questions, please don’t hesitate to contact Monica Robinson at
(804) 525-1854 or mrobinson@cahealthnet.org.

Live Healthy Block Party
in Partnership with

Click here for dates/events.

Sponsorship Opportunities:
- Click here for sponsor letter

Vendor Opportunities:
For non-profits, companies offering products/services or food vendors.
- Click here to become a vendor.