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Event Request Form

Please complete and submit the following information and Clinicas Outreach staff member will contact you.

Date of Request: *

Organization/business requesting: *

Date of Event: *

Time of Event: *

:

am

pm

End Time: *

:

am

pm

Arrive by: *

:

am

pm

Event Name: *

Location: *

Street Address: *

City: *

State: *

Zip: *

Type of Event Requested

Health Screenings:

Blood Pressure

Dental

Glucose

Vision

Body Mass Index (BMI)

Presentation:

Clinicas Services

Hypertension

Nutrition

Anemia

Diabetes

Paza la Voz/ Spread the word

Fit Family Program

Mobile Event:

Medical Mobile

Dental Mobile

Contact Person: *

Phone Number: *

Email Address: *

Number of Participants Expected: *

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News & Events

Clinicas earns Primary Care Medical Home (PCMH) designation

Clinicas del Camino Real, Inc. has earned The Joint Commission’s Gold Seal of Approval™ by...

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Clinicas CEO Issues Statement Concerning Gold Coast Health Plan

Ventura, CA - Roberto Juarez, CEO, Clinicas del Camino Real issued the following statement...

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Upcoming Events

Screenings - Tipsy Fox - Jornaleros Moorpark 2-22-12

Event Date and Time: Wed, 02/22/2012 - 8:00am - 9:00am
Screenings - Amar Ranch Market 2-22-12

Event Date and Time: Wed, 02/22/2012 - 1:30pm - 4:30pm
Screenings - Catholic Charities Oxnard 2-23-12

Event Date and Time: Thu, 02/23/2012 - 9:30am - 12:00pm
Screenings - First 5 Food Pantry - Moorpark 2-23-12

Event Date and Time: Thu, 02/23/2012 - 10:00am - 11:30am
Screenings - First 5 Food Pantry - Simi Valley 2-23-12

Event Date and Time: Thu, 02/23/2012 - 1:00pm - 2:30pm

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This web site is for information and educational use only. It should not be construed as medical
advice or instruction. If you need medical advice, see your health care provider.

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