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Biometric Screening Request Form

If you would like to have a biometric screening at your office please fill out the form below. We will only be able to provide on-site clinics for locations that have 10 or more participants. Please allow 3-5 business days for us to process your request. 

Please note that fields with a red asterisk (*) are required.







Screenings must occur in a private conference room or office. We will supply the appropriate number of nurses to accommodate the volume of the clinic.  Larger clinics will require 2-3 tables (or equivalent table space) to perform the screens.




Please indicate the days that would work for your clinic:


When you would like your clinic to begin and end:

Please note that rooms will need to be reserved 30 minutes before  and after the clinic time to allow for set up and break down.




Approximately how many eligible* individuals are there in your department?
(Please note, we can only provide on-site clinics to locations with 10 or more participants)


Will our nurses be able to access WiFi at this site?

Will this be a private clinic for only your office/department(s), or are employees and spouses from other departments welcome?
(Private clinics require a special registration link)
Are there any special instructions we will need for this clinic? For example, parking, access to the building, nearest elevators, etc.
*For eligibility information, please see our Eligibility and Incentives page.
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