Follow the steps to successfully complete the form

1. Press the ‘Get Form’ button to access the form and open it in your preferred document editor.
2. Begin with the patient information section by entering the patient's name, date of birth, and email address. Ensure that this information is accurate and complete.
3. Next, provide the physician's information. Fill in the physician's office name, office phone number, and office address. Include the date of the visit to ensure proper record-keeping.
4. In the screening section, for each screening listed, input the patient’s results. This includes blood pressure, cholesterol levels, height, waist circumference, weight, BMI, and glucose levels. Be meticulous in entering these values to ensure compliance with annual requirements.
5. The physician must certify the results. The physician should sign and date the form, confirming that the patient received the indicated tests.
6. Subsequently, the patient needs to authorize the release of their screening results. The patient should sign and date the authorization statement to maintain confidentiality.
7. Once the form is completely filled out, it can be saved, downloaded, printed, or shared as needed. Make sure to submit the completed form to Alyssa LaMon via email at a.lamon@wellworksforyou.com or fax it to 610-640-9749 by the designated deadline.

Complete your Wellworksforyou Physician Results Form online today to ensure you meet your preventative care requirements.