Aflac wellness claim form 2026

1. Click ‘Get Form’ to open the Aflac Wellness Claim Form in our editor.
2. Begin by filling in the Policyholder Information section. Enter your first name, middle initial, last name, birth date, and policy number. Ensure all details are accurate for smooth processing.
3. Next, provide Patient Information. Indicate the patient's relationship to the policyholder, their name, sex, and birth date. This is crucial for identifying who the claim pertains to.
4. In the Wellness Exam section, mark only the boxes corresponding to tests you have completed. Be sure to include dates for any mammograms or pap smears performed.
5. Complete the Physician Information section by entering the physician's name, address, and phone number. This helps Aflac verify your wellness exams.
6. Finally, sign and date the form at the bottom. Remember to keep a copy of this completed form for your records before mailing it to Aflac.

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