Mobile Clinic Event Request

To request the use of the Mobile Health Clinic please fill out the form below.  To allow for proper event coordination, please submit your request at least 20 days in advance.  The PHSO will review submitted requests and based on the information included in the Event Request Form, will either approve or deny your request.  You will be notified of the decision within two business days after submission.

Contact Information

Name
Phone Number

Event Details

Is the event sponsored or organized by Sparrow Health System?

Mobile Health Clinic Services

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