Skip to content

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