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Ight measurements. If your results are in range, you will earn additional Vitality Points. Participation points will be awarded once per program year. Complete Section A and have your physician or lab facility complete Sections B and C below. Section A – Member Information First Name: Last Name: Vitality ID: Date of Birth: Consent to Medical Screening and Release Medical Information I consent to the release of my medical information to Vitality or its representatives. A photocopy of this.

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