Transition of Care Questionnaire - Global Benefits Group 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin with Section A: Policyholder Information. Fill in your name, policy number, GBG ID, employer (if applicable), date of birth, address, postal code, country, phone, fax, and email.
3. If applicable, complete Section B: Applicant Information for a spouse or dependent. Include their name, date of birth, address, postal code, country, phone, fax, and email.
4. In Section C: Transition of Care Questionnaire, answer the questions regarding the patient's current health status. Provide details if any answers are 'Yes'.
5. Proceed to Section D: Doctor/Facility Information. Enter the applicant’s doctor or facility name and contact details. Include any relevant treatment history.
6. Finally, complete Section E: Authorization/Declaration by signing electronically and providing your name and date.

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