Peehip wellness form 2025

1. Click ‘Get Form’ to open the peehip wellness form in the editor.
2. Begin with Section 1, where you will enter your Contract Number and Social Security Number (SSN) clearly. Ensure you use a black ink pen for legibility.
3. Fill in the Screen Date and select your gender by darkening the appropriate box completely. Provide your Daytime Phone Number, Last Name, and First Name.
4. Indicate if the screening was not performed due to reasons such as Pregnancy or Disability. Next, select your race/ethnicity from the provided options.
5. Answer questions regarding any health conditions like High Cholesterol or Diabetes, and indicate if you take medication for these conditions.
6. Section 2 is to be completed by your healthcare provider. They will fill in details such as Blood Pressure, Blood Glucose, Total Cholesterol, Height, Weight, and more.
7. Finally, ensure that both you and your healthcare provider sign where indicated before submitting the form via fax or mail to the ADPH Wellness Program.

Start using our platform today to easily complete your peehip wellness form online for free!