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.

The completed Physician Screening Appeal Form is due on or before November 29, 2019. Date of test must be on or after April 1, 2019.

Before you submit your form, make sure you have:

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


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CHG Healthcare is committed to helping you achieve your best health.  If it is unreasonably difficult or medically inadvisable for you to participate in the biometric screening due to a medical condition, you might qualify for an opportunity to earn the same reward by different means. For more information, please contact US Wellness at 1-866-926-6099 x900.