Health Screening Completion Form Globe Corporation 2021

Notice of Privacy Practices

You have 12 full months to complete any of the following screenings (many are covered at 100% -- or free of charge):

  • Health Risk Assessment and Biometric Screening
  • Nutritional or Diabetic Counseling
  • Colorectal Cancer Screening
  • Mammography
  • Tobacco Cessation
  • Alcohol Counseling
  • Mental Health Counseling
  • Two (2) Chiropractic Visits
  • Two (2) Massage or Acupuncture Visits
  • Two (2) Dental Cleanings
  • Prostate DRE/PSA
  • Comprehensive Cardiac Screening
  • Comprehensive Organ Screening
  • Skin Cancer Screening/Lesion Removal

To request a link to a secured encrypted HIPAA-compliant mail system, simply ask by emailing tiffany@ddwconsulting.com

OR

Scottsdale Offices: Seal your contract in a confidential envelope and leave in the Data Driven Wellness Consulting, LLC. mail box located at the front desk in the Globe Corporation office suite.  Mail is picked up on a weekly basis.

Deerfield Offices: Send your form by mail to PO Box 4273, Scottsdale, AZ 85261.

Hall of Flame Firefighter Museum: Send your form by mail to PO Box 4273, Scottsdale, AZ 85261.