Vitality check form 2026

1. Click ‘Get Form’ to open the Vitality Check form in our editor.
2. Begin with Section A, where you will enter your personal information. Fill in your First Name, Last Name, Vitality ID, and Date of Birth. Ensure accuracy as this information is crucial for identification.
3. In Section A, provide your consent for medical screening by signing and dating the consent statement. This allows the release of your medical information to Vitality.
4. Proceed to Section B and input your physician or facility's details. Include their name, address, phone number, and National Provider ID or CLIA number. Also, indicate the test date and check all tests performed.
5. Finally, complete Section C by entering your measure and test results. Fill in values for blood pressure (systolic and diastolic), fasting blood glucose, total cholesterol, height, weight, waist measurement, and any other relevant metrics.
6. Ensure that both you and your physician/nurse sign and date the form before submission.

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