If you wish to override your 2017 screening results record with new test results from your doctor, you may have your healthcare provider complete an appeal or alternative standard form.
In order to have your Healthy Numbers points recalculated, forms must be submitted to US Wellness on or before November 30, 2017 11:59 pm PST.
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 'Choose File' to load your document.
- Click 'Upload Files' to submit your completed form.
For assistance, please contact US Wellness at 866-926-6099 X900 or firstname.lastname@example.org