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Worksite Wellness SCREENING REGISTRATION and CONSENT Name:Date: F Address:Zip CodeTelephone:Name of primary care physician:Email:___ If none, would you like a referral? Y Insurance provider:Date of

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How to fill out peehip wellnessalabama department of

01

Visit the PEHIP Wellness website or contact the Alabama Department of Public Health for the necessary forms.

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Fill out all required personal information, including your name, address, and contact information.

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Provide details about your current health status and any relevant medical history.

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Submit the completed form to the appropriate department for review and processing.

Who needs peehip wellnessalabama department of?

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Employees and eligible dependents enrolled in the Public Education Employees' Health Insurance Plan (PEHIP) in Alabama may need to fill out the PEHIP Wellness form to participate in wellness programs and access health benefits.

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