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Biometric Health Data
2025-2026
Have you received a physical exam or routine bloodwork in the past 12 months? If so, you are able to use this data, or other biometric screening data, in lieu of a screening with the Wellness Program. Enter details here to use in place of your annual wellness program screening. Please contact your Wellness Program Administrator with questions.
PLEASE NOTE THAT ALL FIELDS MUST BE COMPLETE WITH RESULTS IN ORDER TO USE THIS OPTION.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Today's Date
*
-
Month
-
Day
Year
Date
Company
*
Please Select
Davestates
Davmarketing
Davoil & Gas
Davrail
Fort Worth & Western Railoroad
October Hill Farm
Quorum / Cyan / Oxygen / Lavin
Wiseda
Date of your screening / exam
*
-
Month
-
Day
Year
Date
Name of doctor / healthcare provider
*
Were you fasting for this screening / exam?
*
Yes
No
Blood Pressure
*
Weight (lbs.)
*
Blood Glucose (Blood Sugar)
*
Total Cholesterol
*
HDL Cholesterol
*
LDL Cholesterol
*
Triclycerides
*
Do you have a copy of your visit summary or lab work from this visit?
*
Yes
No
Upload any documentation, visit summaries or lab work from your visit here:
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