Firefighters: Request a Screening

Most of the firefighter screenings can be completed during the 2022 Firefighter Screening Day on Saturday, May 14, or you may be scheduled to complete the screenings on another day if that is convenient for you.

Complete the form below and a member of our team will call you to complete registration.

Name(Required)
Date of Birth(Required)
Address(Required)
Drop files here or
Max. file size: 2 MB.
    Screening Services Scheduling Preference(Required)
    If you do not have a PCP and would like to establish with a provider, please contact navigator@crouse.org or call 315-470-8034.
    If you are not currently a member of the YMCA, would you be interested in a FREE eight-week trial?
    By selecting yes, you agree to have the information provided on this form shared with the Intake Coordinator at the YMCA.
    The information you provide on this form will be shared with the screening providers including Crouse Medical Practice, Crouse Radiology Associates, and Hematology-Oncology Associates of CNY