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  • Wellworksforyou Physician Results Form

Get Wellworksforyou Physician Results Form

PHYSICIAN RESULTS FORM PATIENT INFORMATION Patients Name:Date of Birth:Email:PHYSICIAN INFORMATION Physician Office/Name: Office Phone/Address Date of Visit:This Results Form confirms that the patient.

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How to fill out the Wellworksforyou Physician Results Form online

Filling out the Wellworksforyou Physician Results Form online is a straightforward process that ensures you meet your preventative care requirements. This guide provides clear, step-by-step instructions tailored to assist you in completing each section of the form accurately.

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.

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Fill Wellworksforyou Physician Results Form

You can find all the forms for your wellness program in the Wellness Locker on the Portal. It is the to submit the Physician Results Form as part of the wellness program to be returned to Wellworks For. You as outlined below by. The Physician Results Form is an alternative method of completing a biometric screening. Complete an annual physical exam with your physician between NOVEMBER 1, 2021 and OCTOBER 30, 2022.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232