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If you would like to register by phone call (763) 785-8385
Name
*
First
Last
Phone
*
Email
*
Number of Kids
Would you like to registar for a Seminar?
*
Yes
No
Which Seminars would you like to registar for?
*
9:00 a.m. - The 411 on Heavy Menstrual Bleeding: Are Fibroids the Cause?
9:00 a.m. - Heart Disease and Sleep Apnea: What’s the Connection?
10:30 a.m. - Childhood Asthma
10:30 a.m. - Sports Injuries: New Treatment Options for Back, Neck and Shoulder
please check which seminar
Would you like to registar for First Aid and CPR Class?
Yes
No
Which time would you like to registar for?
*
10:00 a.m. - First Aid and CPR
10:30 a.m. - First Aid and CPR
11:00 a.m. - First Aid and CPR
11:30 a.m. - First Aid and CPR
12:00 a.m. - First Aid and CPR
please choose which class for First Aid / CPR
Would you like to registar for Ultrasound Screenings?
*
Yes
No
which screening would you like performed?
*
Uterine Fibroid - (10:00 a.m. – 1:00 p.m.)
Varicose Vein - (9:00 a.m. – 1:00 p.m.)
Abdominal Aortic Aneurysm - 9:00 a.m. – 1:00 p.m.
Peripheral Vascular/Arterial Disease - 9:00 a.m. – 1:00 p.m.
Carotid Artery Disease - 9:00 a.m. – 1:00 p.m.
Venous Disease - 9:00 a.m. – 1:00 p.m.
Gallbladder Disease - 9:00 a.m. – 1:00 p.m.
please choose the screening you would like performed
Would you like to registar for Women’s Cancer Screening
*
Yes
No
You must Pre-register for a Mammogram and Pap test: 763.785.8385
Have you called us for the Women's Cancer Screening?
Yes
No
You must call to registar for the Women’s Cancer Screening - Mammogram and Pap test Call to Pre-register at 763.785.8385
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