Next IHCNJ Event


 

INDIAN HEALTH CAMP OF NEW JERSEY (IHCNJ)

Presents a FREE Health Screening and Prevention Fair in collaboration with

Shree Swaminarayan Temple at

200 Penhorn Avenue, Secaucus, NJ 07094 201-325-0510

With the blessings of Shree Muktajeevan Swamibapa, Indian Health Camp of New Jersey in collaboration with Shree Swaminarayan Temple, Secaucus, NJ is proudly organizing a Health Screening and Disease Prevention Fair for the people over age 40 without medical insurance. If you are younger than 40, you are not eligible to participate.

Sunday, November 12, 2017, 8:30 a.m. - 1:00 p.m.

Basic blood test, electrocardiogram (EKG), eye examination, physical examination, cardiac evaluation and counseling, cancer screening/prevention and education, dental screening, mental health screening, physical therapy, pharmacy and dietary counseling, flu vaccine and other ancillary services.

Note: 12 hours fasting is required for blood test but you can drink plain water. No tea or coffee or anything with suagr. Continue all medications the day before and the day of the blood test. Bring all your medications with you at the health camp. Breakfast will be provided after the blood test is completed.

The screening will be provided to the pre-registered participants only if the application is received at the mailbox address no later than October 30, 2017. Please fill-out one application form per person and include a refundable deposit check of $10.00 per applicant payable to IHCNJ and mail to:   IHCNJ,P.O. Box 5686, Hillsborough, NJ 08844. 

Please note that the $10 deposit will be refunded only if the applicant is present on the day of the camp.

For further information please contact: Mahendra Patel - 201-403-7015 Navin Merai - 908-616-2380 or Dr. Tushar Patel - 848-391-0499 Visit our website at www.IHCNJ.org or contact via e-mail tpatel434@yahoo.com.

Section 1: Patient Information (USE CAPITAL LETTERS ONLY) E-mail address is mandatory

LAST NAME:_______________________FIRST _________________________ MIDDLE___________

Email:___________________________________________________ Phone:__________________

Address: ______________________________________________________________________________

City: ______________________State: ____ Zip Code:______   Home Phone: _____________________


Date of Birth: ____________________ Age: ____ Male ___Female: ___SSN: ______________________

                               (mm/dd/yyyy)

Section 2: Applicant’s Signature is required 

I understand that this health fair is for screening and counseling only. IHCNJ and Shree Swaminarayan Temple will not be responsible for any treatment. I also understand that Shree Swaminarayan Temple, IHCNJ, laboratory, participating health care professionals, organizations and volunteers have no liability for any damage and none of themare responsible for any malpractice occurrence for this particular event. In addition, I understand that Shree Swaminarayan Temple is not in any way affiliated with IHCNJ and is only providing use of their facility for the health camp screening for this day. If you receive someone else’s blood test report by mistake, you are responsible to notify the management and discard the report as soon as possible.

Signature:_____________________________________ Date: _______________________

Online Form: To Print and bring it on the day of the event (Registration Form - Click Here)