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HEALTH HISTORY For Office Use Only: Mm. Record: Complete / Incomplete Reviewed: Entered: Wellness Center 7900 W. Division Street, River Forest, IL 60305 Phone: 708524 6229 Faxes: 7084885072 (Please
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Start by obtaining a please return to wellness form. This can typically be obtained from your wellness provider or human resources department.
02
Fill out your personal information accurately and completely. This may include your full name, date of birth, address, contact information, and any other required details.
03
Next, provide information about your current health status. This may include medical conditions, allergies, medications you are currently taking, and any other relevant health information.
04
If applicable, provide information about your primary care physician or healthcare provider.
05
Indicate any specific wellness goals or areas of focus that you have. This could include weight management, stress reduction, physical fitness, or any other aspect of wellness that you are interested in addressing.
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Sign and date the form, if required.
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Submit the completed please return to wellness form to the appropriate party or department as instructed.

Who needs please return to wellness?

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Individuals who have enrolled in a wellness program offered by their employer or healthcare provider.
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Individuals who are interested in improving their overall well-being and are seeking guidance and support from a wellness program or provider.
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People looking to track their progress and set specific wellness goals.
Remember, it is always a good idea to consult with your wellness provider or human resources department if you have any questions or require further assistance in filling out the please return to wellness form.
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Please return to wellness refers to a form or document that individuals need to fill out when returning to work after a period of illness or injury.
Employees who have been on leave due to illness or injury are typically required to file a please return to wellness form.
To fill out a please return to wellness form, individuals need to provide information about their medical condition, any restrictions or limitations, and a plan for returning to work.
The purpose of please return to wellness is to ensure a smooth transition back to work for employees who have been on leave due to illness or injury.
Information that must be reported on a please return to wellness form includes details about the employee's medical condition, any restrictions or limitations, and a return-to-work plan.
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