Wellworks physician results form 2026

1. Click ‘Get Form’ to open the wellworks physician results form in the editor.
2. Begin by entering the patient information. Fill in the Patient’s Name, Date of Birth, and Email in the designated fields.
3. Next, provide the Physician Information. Enter the Physician Office/Name, Office Phone/Address, and Date of Visit accurately.
4. In the Screening section, ensure you provide results for each screening listed. Input values for Blood Pressure (Systolic and Diastolic), Total Cholesterol, LDL, HDL, Waist Circumference, Weight, BMI, Glucose, and any other required metrics.
5. The Physician must certify that tests were conducted by signing in the designated area and providing the date signed.
6. Finally, have the patient sign to authorize release of their screening results. Ensure they also date their signature.
7. Once completed, submit your form via email or fax as instructed at the bottom of the document.

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