Screening results form health 2025

1. Click ‘Get Form’ to open it in the editor.
2. In Section 1, enter your name, age, date of birth, email, and gender. Ensure all fields are filled accurately as this information is essential for processing.
3. Indicate your status as either an employee or a spouse/domestic partner. Provide your Employee Standard ID and phone number.
4. Sign the authorization section to allow your healthcare provider to fax the completed form. This consent is crucial for sharing your results securely.
5. In Section 2, have your healthcare provider complete their part by filling in details such as cholesterol levels, blood pressure, and other health metrics.
6. Ensure that the healthcare provider signs and dates the form before submission. They can fax or email it directly to Provant Health Solutions within 31 days of your screening date.

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