Health screen form 2026

1. Click ‘Get Form’ to open the health screen form in the editor.
2. Begin by entering your personal information. Fill in your Last Name, First Name, Middle Initial, Date of Birth, Age, Gender, Phone Number, and Email Address in the designated fields.
3. Select one of the options regarding how you will provide your biometrics: either have your physician complete the Biometrics/Clinical Lab Values section or enter information from a previous health evaluation.
4. If applicable, fill in your Physician's Name and Address. Then proceed to the Biometrics/Clinical Lab Values section where you will input details such as Blood Screening Date Completed and whether you were fasting for blood work.
5. Complete the clinical measures by entering your Height, Weight, Blood Pressure, and Pulse Rate. Additionally, indicate your tobacco usage status and frequency of moderate exercise.
6. Finally, review all entered information for accuracy before signing and dating the form at the bottom. Ensure that you understand HIPAA regulations regarding your personal health information.

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