Summit Registration

Home address
City, State, Zip
Occupation
Church home
Race	Asian Black Hispanic White Other
Age
Do you see your doctor at least once a year?
Do you exercise at least twice a week?
Do you practice health eating on a regular basis?
Have you ever been diagnosed with heart disease, high blood pressure, diabetes or high cholesterol?
MEN ONLY: Have you had a prostate exam or PSA test in the last year?

Please answer the simple math question below to submit the form.

2 + 2 =

Billing Information

The Church Health Center seeks to reclaim the Church's biblical commitment to care for our bodies and our spirits. Read more-

1210 Peabody Avenue
Memphis, TN 38104
(901) 272-7170
info@churchhealthcenter.org

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