Get Coupon Incentives For Class Form

This guide provides comprehensive instructions for completing the Coupon Incentives For Class Form online. By following the steps outlined below, users can efficiently submit their required information to receive incentives for breast cancer screenings.

Follow the steps to fill out the Coupon Incentives For Class Form online.

1. Click ‘Get Form’ button to obtain the form and open it in your browser for editing.
2. Begin filling out the form by entering the date of your mammogram in the designated field.
3. In the next field, specify the location where your mammogram was performed.
4. Enter your full name as the member, ensuring it matches the name associated with your UCare membership.
5. Provide your UCare ID number, ensuring it is accurate for proper verification.
6. The technologist who performed your mammogram should sign in the designated area, confirming the procedure has been completed.
7. Fill out the section requesting your name and mailing address to ensure your incentive reward is sent to the correct location. Include your apartment number, city, state, and ZIP code as required.
8. After completing all the necessary fields, review the entire form for accuracy and completeness.
9. Once satisfied with the information provided, save your changes, download the form, and print it, if necessary.
10. Finally, mail the completed coupon to the address listed on the back to receive your incentive reward.

Complete your documents online now to ensure you receive your breast cancer screening incentive.