Multiphasic Registration - VNA of Hanover - 2018


[ FOR VNA OF HANOVER EMPLOYEES ONLY ]
Tuesday, February 6, 2018 | 6:30 - 9:30 a.m.
(snow date is February 20, 2018)

Please provide us with your information below.

* All items are required.

Legal First Name *
Legal Middle Initial * If you do not have a middle name or initial, please type NONE.
Legal Last Name *
Is registrant an Employee, Spouse, Dependent, or Volunteer? *
E-mail *
Gender *
Birthdate * (mm/dd/yyyy)
Race *
Ethnicity *
Language *
Mailing Address *
City *
State *
Zip Code *
Primary Phone *
Provider *
Provider's Name (If NOT in list above)
Preferred Time *

*Note: Cost of testing is FREE for employees, and $32 for Spouses, Dependents, and Volunteers.

Your results will NOT be mailed to you.

You can obtain a copy through the Hospital's Patient Portal or by calling the Release of Information office.

Once you hit submit, you will receive a confirmation page. Please print for your records. NO OTHER CONFIRMATION WILL BE SENT OUT TO YOU.

Click Submit to register:

Questions? Call 717-316-2442.
This registration is accessible from January 1, 2018 through January 16, 2018.