Get Viverae Physician Screening Collection Form

Filling out the Viverae Physician Screening Collection Form online is a straightforward process that allows users to satisfy their biometric screening requirements through their health care provider. This guide provides step-by-step instructions to assist users in accurately completing the form.

Follow the steps to complete the Viverae Physician Screening Collection Form accurately.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by providing your personal information in the designated fields. This includes your name, employer, date of birth, and phone number. Ensure all details are accurate.
3. Next, you will need to provide your health care provider's details. Fill in the provider name or clinic, phone number, address, city, and state.
4. Once you have provided your information, have your health care provider complete the necessary sections. They must fill out the lab and screening tests that have been performed, including the date of the tests.
5. In the tests section, you will need to record values for the following parameters: total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, glucose, systolic blood pressure, diastolic blood pressure, height, weight, and waist circumference. Ensure that each value is entered correctly in the designated field.
6. Indicate whether fasting was done prior to the tests by selecting 'Yes' or 'No' in the fasting section.
7. After completing the form, review all entries for accuracy before submission. Ensure your health care provider has signed the form where required.
8. Finally, you can save changes, download, print, or share the completed form as needed. Ensure that the form is faxed to Viverae at (855) 292-8662 within the required timeframe.

Start completing your Viverae Physician Screening Collection Form online today!