State of alabama wellness screening form 2025

1. Click ‘Get Form’ to open the state of Alabama wellness screening form in our platform.
2. Begin by filling out Section 1, which is for the participant. Enter your name, contract number, appointment date, and social security number. Select your gender and indicate whether you are an employee, spouse, or retiree.
3. Provide your date of birth and age. Next, enter your daytime phone number and select your race/ethnicity from the provided options.
4. Indicate any health conditions you have or have been told you have by marking all that apply in the relevant section. Do the same for any medications you take related to high cholesterol, blood pressure, or diabetes.
5. Once Section 1 is complete, save your progress. The provider will then need to fill out Section 2 with their information including vital statistics like blood pressure and cholesterol levels.
6. After both sections are completed, ensure all fields are filled accurately before submitting the form back to SEIB by the deadline.

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