Get Perafit

The Perafit program offers a comprehensive approach to weight management for individuals covered by Anthem. This guide provides clear instructions for users on how to complete the Perafit online form effectively.

Follow the steps to complete the Perafit form online:

1. Click ‘Get Form’ button to obtain the Perafit form and open it in the editor.
2. Begin by filling out the participant information section. Provide your full name, date of birth, and complete address, including city, state, and zip code.
3. Enter your preferred phone number and select the best time to call from the provided options: morning, afternoon, evening, or weekend.
4. Indicate whether you would like a message left if you are unavailable by selecting 'Yes' or 'No'.
5. If applicable, provide your email address and specify if you need TTY support.
6. In the referring provider section, sign or label with your provider’s information. Include the name of the clinic or facility, address, phone number, and fax number, as the fax number is required for confirmation of referral.
7. The provider must sign and date the referral section to validate the participation of the patient in the program.
8. Complete the participant consent for the release of information section. Fill in your name and sign to give permission for your health care provider to share necessary information with the Perafit program.
9. Finally, review all entries for accuracy, and then you can save changes, download, print, or share the completed form as needed.

Complete your Perafit enrollment online today!