Get Viverae Physician Lab Form

Filling out the Viverae Physician Lab Form online is a crucial step for participants in the Wellness Program. This guide provides detailed instructions to ensure you complete the form accurately and efficiently.

Follow the steps to complete the Viverae Physician Lab Form online.

1. Click the ‘Get Form’ button to obtain a copy of the Viverae Physician Lab Form and open it for editing.
2. Fill in your healthcare provider's name and clinic. Provide their phone number, contact name, title, and address to establish your provider's identity.
3. In the 'Lab & Screening Tests' section, input the results for each test parameter: total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, glucose levels, systolic and diastolic blood pressure, height, and weight. Ensure you enter the values in the correct units.
4. Enter the test date in the provided format (MM/DD/YYYY) to verify when the tests were conducted.
5. Ensure your healthcare provider prints their name and provides their signature in the designated areas to confirm the authenticity of the results.
6. Read and acknowledge the 'Release of Health Information' statement. Fill in your name, signature, phone number, and date of birth as required, ensuring that you understand the consent details regarding your health information.
7. Once the form is fully completed, review all entries for accuracy, and ensure that all necessary signatures are present before proceeding.
8. Save the document to ensure all changes are secured. You can then download, print, or share the form as needed to complete your submission.

Complete your Viverae Physician Lab Form online today to participate in your wellness program.