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20152016 Easter Seals Physician Tracker Form Maximum of 10 Wellness Points from the Physician Tracker Employee Name: (Please Print) Employee Number: Please take this form with you to your next appointment
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How to fill out 2015-2016 - Easter Seals:

01
Obtain the necessary forms. You can typically find the 2015-2016 - Easter Seals forms on the official Easter Seals website or at your local Easter Seals office. Make sure you have the most recent version of the form.
02
Gather all relevant information. Before filling out the form, gather any necessary documentation and information. This may include personal details such as your name, address, and contact information, as well as any supporting documentation related to your eligibility for Easter Seals services.
03
Read the instructions carefully. The 2015-2016 - Easter Seals form will come with instructions on how to fill it out correctly. Take the time to read and understand these instructions before proceeding, as they will help ensure accurate completion of the form.
04
Provide personal information. Begin filling out the form by providing your personal information, such as your full name, date of birth, and Social Security number. Be sure to double-check your entries for accuracy.
05
Answer the questions. The form will likely contain various questions about your medical history, disability status, and any limitations you may have. Carefully respond to each question, providing as much detail as possible to accurately convey your situation.
06
Include supporting documentation. If the form requires any supporting documentation, such as medical records or income statements, make sure to include them as specified. Keep copies for your records, and consider sending the forms via certified mail to ensure they are received.
07
Review and sign the form. Once you have completed all the necessary sections, review the form for any errors or missing information. Sign and date the form where indicated. If applicable, have a legal guardian or representative sign the form on your behalf.

Who needs 2015-2016 - Easter Seals?

01
Individuals seeking services for disabilities: The 2015-2016 - Easter Seals form is typically needed by individuals who are seeking services and support for disabilities. This may include children, adults, or seniors with physical, developmental, or intellectual disabilities.
02
Caregivers and parents: In some cases, caregivers or parents may also need to fill out the form on behalf of the individual with a disability. This is especially common for children or individuals who may have limited capacity to complete the form themselves.
03
Healthcare professionals and service providers: Healthcare professionals or service providers who work with individuals with disabilities may also be required to fill out certain sections of the 2015-2016 - Easter Seals form. This is to provide professional insights and supporting documentation related to the individual's condition and needs.
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Easter Seals is a non-profit organization that provides services to individuals with disabilities.
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