Get 248 864 4409 Fax Form

This guide will assist you in completing the 248 864 4409 Fax Form with ease and accuracy. Follow the step-by-step instructions tailored for users of all experience levels to ensure your submission is processed without issues.

Follow the steps to complete the form successfully.

1. Press the ‘Get Form’ button to access the form and open it in your editor of choice.
2. In Section 1, enter your personal information clearly. This includes your date of birth, gender, member ID, first and last name, address, email address, and phone number. Ensure all fields are legible as illegible forms will not be processed.
3. Indicate your relation to the program by selecting whether you are an employee or a spouse.
4. Answer the smoking status question by selecting 'Yes' or 'No.'
5. Read the disclosure statement carefully. Make sure you understand what information will be released and for what purpose.
6. Provide your signature and the date to confirm your participation and understanding of the disclosure statement.
7. In Section 2, the health care provider will need to fill out the body measurements and biometric results. Ensure that they enter data like height, weight, blood pressure, and other relevant metrics.
8. Once the form is completed, save any changes you have made, and ensure you have a copy for your records.
9. Finally, fax the completed form to Summit Health at the provided number, 248-864-4409, before the specified deadline.

Complete your documents online to ensure a smooth submission process.