Montefiore Medical Center

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:


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.