Biometric Screening Results - Provant Events 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out Section 1 as the participant. Provide your gender, name, age, date of birth, employee status, employee ID, email address, and phone number.
3. Sign and date the form at the bottom of Section 1 to authorize your healthcare provider to send results to Provant.
4. In Section 2, your healthcare provider will need to complete their part. Ensure they provide results from a preventative exam within the last 12 months using the specified CPT codes.
5. Make sure your healthcare provider fills in all required fields including cholesterol levels, blood pressure, BMI, and waist circumference. They should also sign and date this section.
6. Once completed, submit the form via fax or mail as indicated on the document. Remember that all information is confidential.

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