Women's Health Initiative

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Please complete the information below if you have not already registered for Women's Health Initiative.

Thank you!

Please click on link below to register for programs

Program Registration Link

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Please indicate whether you are a new participant who needs to complete the Women's Health Initiative registration, or if you have already completed your initial registration and are registering for Fun with Nutrition on Saturday, July 18, 2026.

New participant needing to register for Women's Health Initiative

Just need to register for program

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Please indicate which screenings you would like completed on June 20, 2026. A representative will contact you for further scheduling.

Mammogram

HPV Cancer Screening

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First Name

* must provide value

Last Name

* must provide value

Street Address

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City

* must provide value

Zip

* must provide value

Contact number

* must provide value

E-mail

* must provide value

Date of Birth

* must provide value

Y-M-D

Age (years)

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Race & Ethnicity

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• American Indian or Alaska Native

• Asian

• Black or African American

• Hispanic or Latino

• Middle Eastern or North African

• Native Hawaiian or Pacific Islander

• White

• Prefer not to answer

Are you a Cleveland Clinic patient

Yes

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Have you seen a provider/ doctor in the past 2 years?

* must provide value

Yes

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What types of community programs would you like to see offered? (Check all that apply)

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Cooking demonstrations/ Nutrition Education

Budgeting/ financial planning

Safety

Mental Health / Stress management

Resume building / career readiness

Technology Training

Creative skills (writing, music, etc., if you want to expand arts & culture)

Other

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How did you hear about the program?

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Flyer

Social Media

Friend/ Family

Employee Communication

Referral from partnering organization/ agency

Name of referring organization/ agency

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