Get Health Screening Form

Filling out the Health Screening Form online is an important step in participating in your health assessment. This guide will walk you through each section of the form to ensure a smooth and efficient submission process.

Follow the steps to successfully complete the Health Screening Form online.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred editing tool.
2. Begin by providing your name in the designated field, ensuring it is printed clearly.
3. Enter your birth date in the format of MM/DD/YYYY.
4. Fill in your email address and contact phone number, ensuring accuracy for any follow-ups.
5. Indicate if you are a Miami employee and the subscriber of Miami's health plan by selecting ‘Yes’ or ‘No’. If yes, please enter your UniqueID. If no, enter your spouse or partner’s UniqueID followed by ‘_sps’.
6. Provide your home address, including street, city, state, and zip code.
7. State your physician or practice name clearly.
8. Read the permissions regarding the sharing of your biometric data and ensure you understand the consent. Initial where required.
9. Provide your signature and the date to confirm your consent.
10. The clinical lab values section will be completed by your physician's office; ensure they have accurate information regarding your biometric data.
11. Upon completion, save changes to the form. You may download, print, or share the completed form as needed.

Start filling out your Health Screening Form online today for a healthier tomorrow!