Fourth Annual Prostate Cancer and Men's Health Awareness Fair

September 27th, 2025 from 9am-12pm

40 Enterprise Pkwy, Hampton VA

Hosted by Hampton University's Proton Therapy Institute in partnership with Sentara Health.

To expedite registration for a prostate screening, please complete the form below.

Your Information

Note: Asterisk * indicates a required field

Form

First name*

Last name*

Date of birth*

Birth Month

Birth Day

Birth Year

Home address 1*

Home address 2

City*

State*

ZIP code*

Best contact number with area code*

Email address*

Prostate cancer screenings consist of a PSA (blood) test with optional digital rectal exam. A digital rectal exam (DRE) is when a provider places a gloved finger into your rectum to assess for any abnormal changes to your prostate. Screening guidelines recommend the first line test as the blood test. The risks and benefits of both exams will be discussed to you during your "shared decision making" with a provider.

If you would like a digital rectal exam, please select the appropriate response below.* Yes No

Have you attended the HUPTI Men's Health Fair before?* Yes No

What is the name of your primary care provider? If you don't have a primary care provider, please type "N/A"*

Do you have health insurance?

Those who are uninsured will be screened for assistance before the event.* Yes No

If you have health insurance, please write the insurance carrier name and ID in the text space below.

Ex: Sentara Health Plans Member ID 12345678

If you do not have health insurance please type "N/A".*

To have a prostate screening, you must meet clinical eligibility criteria.

Eligibility Criteria:
- Black men and those at high-risk (at least 2 first degree relatives) can start screenings at age 40 and older.
- Average risk men can start screenings at age 50.
- You do not currently have any symptoms of prostate cancer (ex. new pain, trouble peeing, etc.)
- You do not have a current diagnosis of prostate cancer.
- You are not currently undergoing treatment for prostate cancer.
- You have not had a prostate cancer screening within the past 12 months.

By clicking yes, you acknowledge you meet clinical eligibility criteria.* Yes No