Community event inquires

Open Health Care Clinic believes access to affordable, quality care to anyone through all lifespans. We strive to be a beacon in the health care education, prevention and service providing expert healthcare to the Baton Rouge and surrounding areas.

Open Health Care Clinic is able to bring out our Mobile Unit for health screenings or participate in community or health care events by providing a table with various health care information.

Complete the form below at least 8 weeks prior to your event.

Individual Requesting

First Name

Last Name

Requester Email

Requester Phone Number

(###)

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Group or Organization Making Request

Organization Phone Number

(###)

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Organization Email

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Brief Description of Event

Anticipated # of Participants

Location of Event

Date and Time of Event

What is your specific request of Open Health Care Clinic?

How is your event being publicized?

What else do we need to know about this request/event?

How did you hear about Open Health Care Clinic?

Community Event Inquires

Community event inquires

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