Welcome!

   


We are very pleased that you have decided to take advantage of this wonderful opportunity to become better informed about your health. This health questionnaire is designed to accompany the health screenings offered Mercy Tiffin Hospital and Heidelberg University on November 10-14, 2014.

Please complete the online questionnaire prior to your health screening in order to receive:

  • a complete blood panel including glucose, total cholesterol, HDL, LDL and triglycerides
  • an assessment of your personal risk for the development of coronary heart disease, type 2 diabetes, stroke, congestive heart failure, lung cancer and COPD for smokers,

To register for your health screening, please follow these simple steps.

STEP 1:

After reading these instructions, click Enroll Now below.  Notice, once you begin the process, you must finish it at one sitting.  You cannot return to complete your questionnaire at a later time.

STEP 2:

Complete the enrollment form and the medical questionnaire.  You will be asked for a Participant ID.  Please use your first initial, full last name, and last four digits of your Social Security Number as your Participant ID.

STEP 3: At your screening, the required blood panel testing and the clinical measurements will be done. Prior to your appointment, you are required to fast for at least 8 hours before testing (nothing by mouth except water, medications, and black coffee).

If you experience difficulties trying to register, please contact

Jana Martin @ 419-455-7751

who can further assist you.

Click the link below to proceed with registration.