If you received your lab results from a health care provider within the last 6 months please complete the required screening form to determine eligibility and/or update your baseline screening results in the Associate Health Improvement Program.

 

Date of test must be within the last 6 months of form submission.

 

Before you submit your form, please complete the following steps:
  • Completed top section of form
    • Step 1: Fill out your information including email address.
    • Step 2: Ensure you have signed your form.
      • Ensure that you complete Step 3 in its entirety.
      • A completed lab report must accompany submission of this form.

 

To submit your screening form and lab report, complete the fields below. Click Choose File to load your document, then click Upload Files.

 

Personal Details
 Date Format: YYYY-MM-DD
Upload Files
For assistance, please contact US Wellness at (301) 926-6099 x900.