Fill out form or call
1-480-767-3227
Appointments are scheduled as:
Office Visits, Home Visits,
Corporate Office Visits,
or Public Screening Events
For a list of our public screening events, please click:
Public Screening Events
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First Name
*
Last Name
Street Address
City
State
(currently in AZ only)
Arizona
Zip Code
*
Phone Number
*
Email Address
*
Please pick the type of event you would like to schedule.
Office Visit
90 Day Challenge Follow-Up Screen
Please Come to My Home (additional fees may apply)
Corporate Wellness Event
I would like to host a Public/Private Screening
Tell us about the attendees.
Who referred you to us? If no one, simply type "self".
Note:
Discounts apply for larger groups.
*
Have you, or your company been screened by Cardio Centrix before?
yes
no
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How many will receive a screening?
1-5 Screens - $75 each
6-10 Screens - $65 each
11+ Screens - $60 each
60 Day Challenge Follow-Up
90 Day Challenge Follow-Up
I'm not sure
other
Choose A Date
Note: A Representative will contact you within 24 hours,
during regular work hours, to schedule your test. Regular
work hours are M-F from 8:00a.m. - 5:00p.m.
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Date Requested
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Preferred Time
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Second Choice
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Preferred Time
Comments
*
Indicates Response Required