7045 N. Armenia Avenue
Tampa, FL 33604


Health Form

Full Name*
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Complete Address*
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I have chosen to have the following screening test*
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I understand that :

  • I must be at least 18 years old or 16 years old if living dependently from parents to have the screening test or immunizations performed that I have selected.
  • Test results are for screening purposes only and is not a substitute for evaluation, advice, treatment or diagnosis by a physician.
  • Results I receive that are reported as abnormal (if they fall out of the normal range established for the above test(s) may not indicate sickness or disease.
  • Results of my screening(s) will be kept confidential.

I will not hold Apostolic Gospel Temple and The Board, or employees liable for any outcomes that may occur from my voluntary participation in this testing.

Submission of this electronic form, I acknowledge that I have read the foregoing disclaimer, understand it and sign it voluntarily as my own free act and deed; no oral representations, statements, or inducements, apart from the foregoing written disclaimer, have been made; I am at least eighteen (18) years of age and fully competent; and I execute this release for full complete consideration.

Parent / Guardian
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Apostolic Gospel Temple

Remembering without ceasing your work of faith, and labour of love, and patience of hope in our Lord Jesus Christ, in the sight of God and our Father.

Focused on declaring the gospel of Jesus Christ and helping those in the faith to develop strength and endurance in a world of turmoil. The magazine promotes churches and events related to gospel.

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