The offsite biometric screening form is used for those who are unable to attend an onsite screening and/or choose to submit results obtained by a physician.

 

Completed form is due on or before October 31, 2019 by 11:59 pm CST. Date of test must be on or after January 1, 2019.

 

Before you submit your form, make sure you have:
  • Completed top section of form
    • Step 1: Fill out your information AND include email address.
    • Step 2: Ensure YOU have signed your form. Without your signature, this form will not be accepted.
  • Asked your physician to complete Step 3 in its entirety

 

To submit your form, complete the fields below. Click browse to load your document, then click Upload.

 

The uploader is not available at this time.

For assistance, please contact US Wellness at (301) 926-6099 x900.