Form preview

Get the free Statement of Health template

Get Form
This document provides instructions for the completion of the Statement of Health and Authorization form required for group insurance coverage. It details the responsibilities of the recordkeeper, employee, and proposed insured to collect necessary information for insurance underwriting. It also outlines the call and submission instructions for completed forms, as well as the potential for additional medical information requests.
We are not affiliated with any brand or entity on this form

Get, Create, Make and Sign statement of health template

Edit
Edit your statement of health template form online
Type text, complete fillable fields, insert images, highlight or blackout data for discretion, add comments, and more.
Add
Add your legally-binding signature
Draw or type your signature, upload a signature image, or capture it with your digital camera.
Share
Share your form instantly
Email, fax, or share your statement of health template form via URL. You can also download, print, or export forms to your preferred cloud storage service.

How to edit statement of health template online

9.5
Ease of Setup
pdfFiller User Ratings on G2
9.0
Ease of Use
pdfFiller User Ratings on G2
To use the professional PDF editor, follow these steps below:
1
Register the account. Begin by clicking Start Free Trial and create a profile if you are a new user.
2
Prepare a file. Use the Add New button to start a new project. Then, using your device, upload your file to the system by importing it from internal mail, the cloud, or adding its URL.
3
Edit statement of health template. Rearrange and rotate pages, add and edit text, and use additional tools. To save changes and return to your Dashboard, click Done. The Documents tab allows you to merge, divide, lock, or unlock files.
4
Save your file. Choose it from the list of records. Then, shift the pointer to the right toolbar and select one of the several exporting methods: save it in multiple formats, download it as a PDF, email it, or save it to the cloud.

Uncompromising security for your PDF editing and eSignature needs

Your private information is safe with pdfFiller. We employ end-to-end encryption, secure cloud storage, and advanced access control to protect your documents and maintain regulatory compliance.
GDPR
AICPA SOC 2
PCI
HIPAA
CCPA
FDA

How to fill out statement of health template

Illustration

How to fill out statement of health form

01
Gather personal information: Start by collecting your full name, date of birth, and contact information.
02
Read instructions carefully: Make sure to understand each section of the form before filling it out.
03
Provide medical history: Fill out your medical history including past illnesses, surgeries, and any current medications.
04
Answer health questions: Complete any specific health questions asked in the form honestly.
05
Review family medical history: If applicable, include information about your family's health issues.
06
Sign and date: After completing the form, sign and date it to certify that the information provided is accurate.
07
Submit the form: Send the completed form to the designated authority as instructed.

Who needs statement of health form?

01
Individuals applying for life insurance or health insurance plans.
02
People seeking employment where health verification is required.
03
Participants in certain athletic programs or activities that require a health clearance.
04
Patients undergoing specific medical procedures needing pre-authorization.

What is Statement of Health Form?

The Statement of Health is a document required to be submitted to the specific address in order to provide certain info. It needs to be filled-out and signed, which can be done manually in hard copy, or via a certain software e. g. PDFfiller. This tool helps to fill out any PDF or Word document right in the web, customize it depending on your purposes and put a legally-binding electronic signature. Once after completion, user can easily send the Statement of Health to the appropriate person, or multiple recipients via email or fax. The blank is printable as well due to PDFfiller feature and options presented for printing out adjustment. Both in digital and in hard copy, your form should have a organized and professional appearance. It's also possible to turn it into a template for further use, so you don't need to create a new blank form from the beginning. All you need to do is to amend the ready document.

Template Statement of Health instructions

Once you're about filling out Statement of Health Word template, be sure that you prepared enough of information required. It's a mandatory part, because some errors can bring unpleasant consequences starting with re-submission of the whole template and completing with deadlines missed and even penalties. You have to be especially observative filling out the figures. At first glimpse, this task seems to be dead simple thing. Nevertheless, it is simple to make a mistake. Some use some sort of a lifehack saving everything in another file or a record book and then insert this information into documents' samples. In either case, put your best with all efforts and present actual and solid data with your Statement of Health word template, and check it twice during the process of filling out the required fields. If you find any mistakes later, you can easily make corrections when you use PDFfiller editor and avoid blowing deadlines.

Frequently asked questions about Statement of Health template

1. Is it legit to complete forms electronically?

In accordance with ESIGN Act 2000, forms written out and authorized by using an e-signing solution are considered to be legally binding, equally to their physical analogs. As a result you are free to fully fill out and submit Statement of Health form to the establishment required using electronic signature solution that meets all the requirements according to particular terms, like PDFfiller.

2. Is it secure to submit sensitive information on the web?

Of course, it is completely risk-free if you use trusted product for your work-flow for such purposes. For example, PDFfiller has the benefits like these:

  • All data is stored in the cloud supplied with multi-layer encryption, and prohibited from disclosure. It's only you the one who controls to whom and how this word file can be shown.
  • Every single document signed has its own unique ID, so it can’t be faked.
  • User can set extra security like authentication of signers via picture or security password. There's also an folder encryption option. Just place your Statement of Health writable form and set a password.

3. Is it possible to transfer my data to the fillable form?

To export data from one file to another, you need a specific feature. In PDFfiller, we've named it Fill in Bulk. Using this one, you'll be able to export data from the Excel spreadsheet and insert it into the generated document.

Fill form : Try Risk Free
Users Most Likely To Recommend - Summer 2025
Grid Leader in Small-Business - Summer 2025
High Performer - Summer 2025
Regional Leader - Summer 2025
Easiest To Do Business With - Summer 2025
Best Meets Requirements- Summer 2025
Rate the form
4.8
Satisfied
37 Votes

For pdfFiller’s FAQs

Below is a list of the most common customer questions. If you can’t find an answer to your question, please don’t hesitate to reach out to us.

By integrating pdfFiller with Google Docs, you can streamline your document workflows and produce fillable forms that can be stored directly in Google Drive. Using the connection, you will be able to create, change, and eSign documents, including statement of health template, all without having to leave Google Drive. Add pdfFiller's features to Google Drive and you'll be able to handle your documents more effectively from any device with an internet connection.
In order to fill out documents on your iOS device, install the pdfFiller app. Create an account or log in to an existing one if you have a subscription to the service. Once the registration process is complete, upload your statement of health template. You now can take advantage of pdfFiller's advanced functionalities: adding fillable fields and eSigning documents, and accessing them from any device, wherever you are.
On an Android device, use the pdfFiller mobile app to finish your statement of health template. The program allows you to execute all necessary document management operations, such as adding, editing, and removing text, signing, annotating, and more. You only need a smartphone and an internet connection.
The statement of health form is a document used to provide information about an individual's health status, typically required by insurance companies or employers for underwriting purposes.
Individuals applying for life insurance, health insurance, or certain employment positions may be required to file a statement of health form.
To fill out a statement of health form, individuals should carefully read the instructions, provide accurate personal information, answer health-related questions truthfully, and sign the form as required.
The purpose of the statement of health form is to assess an individual's health risk and eligibility for insurance coverage or employment.
Typically, the form requires information about personal health history, current health status, medications, and any pre-existing conditions.
Fill out your statement of health template online with pdfFiller!

pdfFiller is an end-to-end solution for managing, creating, and editing documents and forms in the cloud. Save time and hassle by preparing your tax forms online.

Get started now
Form preview
If you believe that this page should be taken down, please follow our DMCA take down process here .
This form may include fields for payment information. Data entered in these fields is not covered by PCI DSS compliance.