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