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Get Vitality Check Form Biometrics Screenings

Ight measurements. If your results are in range, you will earn additional Vitality Points. Participation points will be awarded once per program year. Complete Section A and have your physician or lab facility complete Sections B and C below. Section A – Member Information First Name: Last Name: Vitality ID: Date of Birth: Consent to Medical Screening and Release Medical Information I consent to the release of my medical information to Vitality or its representatives. A photocopy of this.

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