Get We36762014 0108 Form

Filling out the We36762014 0108 form online is a straightforward process designed to streamline your wellness screening submission. This guide will provide you with clear, step-by-step instructions to ensure that you complete the form accurately and efficiently.

Follow the steps to complete the We36762014 0108 form online.

1. Click ‘Get Form’ button to obtain the form and open it in your browser.
2. Begin by filling out the Patient Information Section. This includes entering your first name, middle initial (if applicable), last name, gender, address, and contact number.
3. Include your Cigna account number and the last four digits of your Social Security number for identification.
4. Provide your date of birth and today's date in the specified format.
5. Sign the form to confirm that the information is true and accurate. Ensure that the signature is dated as well.
6. In the Health Measurement Section, have your physician or licensed medical professional fill out the required biometric measurements including blood pressure, fasting blood sugar, total cholesterol, LDL cholesterol, BMI, height, and weight.
7. The physician must print their information, including their name, address, and title. They must also sign and date the form.
8. Review all sections to ensure clarity and completeness, as forms filled out improperly may be returned.
9. Once completed, save the changes, and you can either download or print the form for submission. You may also need to fax or mail it to Cigna.

Complete your wellness screening form online today to ensure timely processing.