CHC Blood Pressure Screening

Heritage Farmers Market • Saturday, October 10, 2026 • 9 AM–2 PM

8303 Rochester Ave, Rancho Cucamonga, CA 91730

Please complete this form with the screening team. Staff will enter your reading. Choose separately whether to receive your reading by text and whether you would like optional educational follow-up.

First Name

Last Name

Phone *

Email *

Systolic BP (top number, mmHg) *

Diastolic BP (bottom number, mmHg) *

Optional text permissions: Message frequency varies; message and data rates may apply. Reply STOP to opt out or HELP for assistance. Consent is not required for screening, services or purchase. BP texts may be visible to others with access to your phone. Privacy: https://gochc.org/privacy-policy | Terms: https://gochc.org/terms-and-conditions

CHC Event BP Text Consent

Yes, I consent to CHC texting my BP screening results.

CHC Event Education Text Consent

Yes, I consent to optional automated CHC educational follow-up texts about family priorities and financial protection, including life insurance education and appointments with licensed professionals.