2026 CPH Women & Babies Fair

Women and Babies Health Fair

Pre-Registration Form

Saturday, May 9th, 2026 | 9:00a.m. - 1:00p.m.

For the most accurate results, please fast for 10hrs before your blood draw. Fasting means you should not eat or drink anything except water. It is important to stay well hydrated while fasting. Refreshments will be available after your lab work has been collected.

PLEASE NOTE: Lab draws will only be completed between the hours of 9a.m. and 11a.m. You must arrive before 11 a.m. to have your blood drawn.

First*

Middle

As it appears on License

Last*

DOB*

Date of Birth

Gender*

Email*

Confirmation Emailexample@example.com

MyChart Account?*

Do you currently have a MyChart Account? Results will be delivered to MyChart Accounts. If no MyChart account, results will be sent by mail.

Phone#*

Please enter a valid phone number.Format: (000) 000-0000.

Address

Street Address

Street Address Line 2

CityState

Zip Code

Labs (Collected 05/09/26)

Chemistry/Hematology Panel: CBC (85027) CMP (80053) Lipid (80061)

CBC (Complete Blood Count) checks your red blood cells, white blood cells, and platelets. It can help identify conditions such as anemia, infection, or other blood disorders.

CMP (Comprehensive Metabolic Panel) measures blood sugar, electrolytes, kidney function, and liver function to help evaluate how well your body’s organs are working.

Lipid Panel measures cholesterol and triglycerides, which helps assess your risk for heart disease and stroke.

$40.00

Thyroid Stimulating Hormone: TSH (84443)

This test checks how well your thyroid gland is working. The thyroid controls metabolism, energy levels, and body temperature. Abnormal results may indicate an underactive or overactive thyroid.

$30.00

Vitamin D 25-Hydroxy: Vit D (82306)

This test measures the amount of vitamin D in your blood. Vitamin D is important for bone health, immune function, and muscle strength. Low levels are common and may lead to bone weakness or fatigue.

$35.00

Hemoglobin A1C: HbA1C( 83036)

This test measures your average blood sugar level over the past 2–3 months. It is commonly used to screen for diabetes or prediabetes and to monitor blood sugar control in people with diabetes.

$35.00

HCG Pregnancy Test: HCG (84703)

A qualitative human chorionic gonadotropin (HCG) pregnancy test checks for the presence of HCG in your blood or urine. HCG is a hormone produced during pregnancy.

$30.00

Prostate Specific Antigen: PSA (84153)

MALES ONLY Measures protein levels in the blood to screen for prostate cancer, monitor treatment, or detect potential prostate issues in men.

$35.00

Total

$0.00

*You must be 18 years or older to have blood work done. Continue taking medications as prescribed. Payment will be made at the health fair via check, cash, or card. Insurance will not be taken at the Health Fair, but you will be able to submit receipts to insurance for reimbursement.

Remember to Fast! (Nothing to eat or drink 10 - 12 hours prior to labs, water is okay and encouraged!)

Signature*