Skip to content
Check Screen Reader Mode to make this survey compatible with screen readers.
Check Screen Reader Mode to make this survey compatible with screen readers.

Fresno County Rural Mobile Health Event Survey

Is your agricultural business or rural community site interested in having a rural mobile health event? If so, please complete the following survey.
1.Contact's Name:(Required.)
2.Contact's Phone Number:(Required.)
3.Contact's Email:(Required.)
4.Name of Organization:(Required.)
5.Event Address (*Please list out full street address):(Required.)
6.Does your facility have enough space to host a mobile health event?
(*Note: This location should include enough space to accommodate a rural mobile health medical unit. Please allocate a minimum of 4 hours for a mobile health event at your venue, which allows time for set up and delivery of medical services.)

Vehicle Dimensions:
  • The UCSF Fresno RV is 33ft by 9ft wide. This unit can fit in five parking stalls.
  • Fresno State’s Mobile Health Unit in collaboration with Saint Agnes Medical Center: The mobile health unit is 60ft long but will need a total space of 100ft to turn and maneuver.
(Required.)
7.Site Map: Please upload any pictures of the site or a map of the event layout.
No file chosen
8.Event Accessibility:

*Is this a Public or Private event?(Required.)
9.Attendance: How many people do you anticipate participating in this event?(Required.)
10.Event Supplies: Will the event host be able to provide any of the following? (*Please select all that apply)(Required.)
11.For an event of this type, which day of the week works best for your organization? (*A minimum 2-week lead time is required for requests)(Required.)
12.Please, provide the top three dates your organization is available for this event?(Required.)
Date
Time Frame
1
2
3
13.Is this location interested in hosting a reoccurring clinic?(Required.)
14.Do you have any questions or feedback?(Required.)
Current Progress,
0 of 14 answered