Comprehensive Cholesterol Screening Registration - East Jefferson General Hospital

High cholesterol is one of the major controllable risk factors for coronary heart disease, heart attack, and stroke. And since high cholesterol has no symptoms, the only way to know your cholesterol levels is by having them checked.

Register for your Comprehensive Cholesterol Screening by filling out the form below. Cholesterol Screenings are avaialble for $30 ($40 for nonmembers) at The Wellness Center. Included in the screening are Total Cholesterol, HDL, LDL, TC/HDL ratio, Triglycerides, Glucose, and Blood Pressure.
- First Name*
- Last Name*
- Membership Number
- Date of Birth*
  MM slash DD slash YYYY
- Gender*
  - Male
  - Female
- Marital Status*
  - Married
  - Single
  - Undisclosed
- Emergency Contact Name*
- Emergency Contact Number*
- Height*
- Weight*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
- Home Phone*
- Other Phone*
- E-Mail Address*
- Current Employer*
- Occupation*
- How would you like to be contacted?*
  - Phone
  - E-Mail
  - Letter
Questions? Call The EJGH Wellness Center at (504) 503-6868.
Phone
This field is for validation purposes and should be left unchanged.