Home
Forms Library
Wellness provider screening form

VOLUNTARY HEALTH SCREENING 2025

wellness provider screening form Preview on Page 1

See details

4.9 out of 5

28 votes

The document is a Provider Screening Form for the Local Government Health Insurance Board's Wellness Program, requiring participants to voluntarily disclose health information related to conditions like high blood pressure, obesity, high cholesterol, and diabetes. It outlines the process for completing the screening, privacy protections for personal health information, and emphasizes that participation is not mandatory. The form must be submitted by specific deadlines and includes sections for participant and provider details.

Here's how it works

01. Edit your wellness provider screening form online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send it via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out VOLUNTARY HEALTH SCREENING with our platform

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click ‘Get Form’ to open the VOLUNTARY HEALTH SCREENING in the editor.
Begin by reading the Notice Regarding Wellness Program. Acknowledge your understanding and agreement by signing in the designated area.
In SECTION 1, fill out your personal information including Name, Insurance Number, Group Number, Date of Screening, Gender, Age, Last Four SSN #, Date of Birth, Day Time Phone Number, and Email.
Indicate any medical conditions you have or have been told you had by marking the appropriate boxes for High Cholesterol, High Blood Pressure, Diabetes, or N/A.
Next, specify if you take medication for any of these conditions by marking the relevant options.
SECTION 2 is to be completed by your provider. Ensure they fill out all required fields including lab results and their contact information.
Review all entries for accuracy before submitting. Remember that incomplete forms will not be processed.

Start filling out your VOLUNTARY HEALTH SCREENING form today on our platform for free!

See more VOLUNTARY HEALTH SCREENING versions

We've got more versions of the VOLUNTARY HEALTH SCREENING form. Select the right VOLUNTARY HEALTH SCREENING version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2022	4.9 Satisfied (28 Votes)
2014	4 Satisfied (49 Votes)

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is a health screening at school?

Schoolwide screenings can be conducted to identify students that would benefit the most from SBHC programs. Some examples include obesity, sexually transmitted infections, asthma, oral health, and mental health. Screenings can also be used as a means to register new students.

What is a health screening consist of?

Health professionals often think of screening for early diagnosis of cancer (such as Pap smears for cervical cancer or colonoscopy for colon cancer), but there are many other screening tests commonly used, for example, thyroid-stimulating hormone (TSH) for congenital hypothyroidism in newborns, cholesterol level for

What is a screening test for school?

A screening test is done to find possible disorders or diseases in children who dont have any symptoms. The goal is to find a disease early so that changes can be made and your child can be watched more closely to lower their chance for the disease.

What do they test for in a wellness screening?

A wellness screening generally consists of routine blood work and biometrics (body measurements). These results can inform you of your current state of well-being so that you can assess any necessary lifestyle adjustments or conversations with your primary care provider.

Are health screenings worth it?

Thats what screening tests are designed to do. Some screenings can reduce your risk of dying from the disease. But sometimes, experts say, a test may cause more harm than good. Before you get a test, talk with your doctor about the possible benefits and harms to help you decide whats best for your health.

What is the purpose of a health screening?

A school health assessment helps to identify strengths and weaknesses of school health policies and programs and provide direction for school health improvement efforts.

VOLUNTARY HEALTH SCREENING 2025

Here's how it works

How to use or fill out VOLUNTARY HEALTH SCREENING with our platform