Well-Being Screening July 2024

Health Screening - McFarland - 7/19/24
- Fast for 12 hours before your screening while staying hydrated with plain water.
- Location: Stoughton Health Urgent Care in McFarland.
- Address: 5614 US-51, McFarland, WI.
- Questions: email ASaul@StoughtonHealth.com or call 608-877-3485.
- Financial assistance is available, please contact us for more information. Thank you!
Your Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Gender*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail*
example@example.com
Phone Number*
Employer/Organization*
If not employed or retired, please say N/A
Activity Level*
On a Scale of 1 to 5. 1 being sedentary, 5 being very active.
Select Date and Time Slot (7/19)*
List of screening categories:
- Blood Pressure
- Blood Glucose (Blood Sugar)
- Functional Movement Screen
Also included is a one on one coaching session for goal setting, answering questions, and education on the screening numbers. Please sign up for coaching by following the link in your confirmation email.
Additional Comments and Questions
Online Payment Option (Cash or check is okay in person on screening day).
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Stoughton Health Well-Being ProgramThis cost includes your Health Risk Assessment, use of the health shelf database, screening day, and one follow-up education and coaching meeting.
$25.00



Additional 6 months of coachingCoaching takes place every 4-6 weeks. This can be added after the screening or your first coaching session.
$60.00



Additional 9 months of coachingCoaching takes place every 4-6 weeks. This can be added after the screening or your first coaching session.
$75.00



Total

$0.00

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

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Health Screening - McFarland - 7/19/24