2019 Health Screening Completion Form Globe Corporation

Download the above PDF

Health Screening Completion Form Instructions

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.