Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Complete Section 1 with your personal information. This includes your first name, last name, date of birth, age, address, city, state, zip code, and the first four letters of your last name or the last four digits of your Social Security number. Ensure that this information is accurate and legible.
3. Read the disclosure statement carefully. Understand the implications of sharing your health screening results and indicate your agreement by signing and dating the form in the designated areas.
4. Move to Section 2, where your physician or provider will need to fill out additional health screening information. This includes height, weight, blood pressure readings, and cholesterol levels. Ensure your provider completes this section clearly.
5. In Section 3, your provider must verify the information supplied as complete and accurate. This includes providing their facility name, phone number, signature, and date of signing.
6. Review the entire form to confirm that all sections are completed accurately. Once validated, you may save your changes, download a copy, print it, or share the form as needed.

Complete the Beneficially Flourish form online today for a healthier tomorrow.