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Screening results form health 2026
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- Click ‘Get Form’ to open it in the editor.
- 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.
- Indicate your status as either an employee or a spouse/domestic partner. Provide your Employee Standard ID and phone number.
- Sign the authorization section to allow your healthcare provider to fax the completed form. This consent is crucial for sharing your results securely.
- In Section 2, have your healthcare provider complete their part by filling in details such as cholesterol levels, blood pressure, and other health metrics.
- 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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biometric screening form pdf
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