Next IHCNJ Event


 

INDIAN HEALTH CAMP OF NEWJERSEY (IHCNJ)

Presents a FREE Health Screening and Prevention Camp in collaboration with

Durga Mandir

4240 Route 27, Princeton, NJ 08540, 609-683-4015

With the blessings of Goddess Durga, Indian Health Camp of New Jersey in collaboration with Durga Mandir, Princeton, 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, August 26, 2018, 8:30 a.m. to 1:00 p.m.

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

Note: 12 hours fasting is required for blood test. 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 August 15, 2018. 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: Mahesh Advani 732-718-0099 Dr. Tushar Patel - 848-391-0499 or Shirish Parekh - 908-468-7829 Visit our website at www.IHCNJ.org or contact via e-mail tpatel434@yahoo.com

Section 1: Patient Information (USE CAPITAL LETTERS ONLY)

LAST NAME:_______________________FIRST _________________________ MIDDLE___________

Email:___________________________________________________ (IHCNJ will send Reg. Confirmation at this email)

Phone:_____________________ Mailing 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 DurgaMandir will not be responsible for any treatment. I also understand that DurgaMandir, IHCNJ, laboratory, participating health care professionals and volunteers have no liability for any damage nor any of themresponsible for any malpractice claimfor this particular event. In addition, I understand that the DurgaMandir is not in any way affiliated with IHCNJ and is only providing use of their facility for the health camp screening for this day.

Signature:_____________________________________ Date: _______________________

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