State of alabama wellness screening form 2026

1. Click ‘Get Form’ to open the state of Alabama wellness screening form in our editor.
2. In Section 1, begin by entering your name and insurance number. Ensure all details are printed clearly for accuracy.
3. Fill in your appointment date, social security number, gender, age, and date of birth. Provide a daytime phone number for contact purposes.
4. Select your race/ethnicity from the provided options. This information is important for demographic purposes.
5. Indicate any health conditions you have or have been told you have by marking the relevant boxes for high cholesterol, high blood pressure, or diabetes.
6. If applicable, mark whether you take medication for any of these conditions.
7. Once Section 1 is complete, share the form with your provider so they can fill out Section 2 with necessary health measurements and their signature.

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