INSTRUCTIONS FOR COMPLETING THE WELLNESS ASSESSMENT FORM

We respect your privacy. Your answers are confidential and will not be given to your employer or any clinician who has not provided care to you.
We will review your answers to see if we can offer you additional resources or support. We may also review your answers with your clinician if doing so could help you.
We encourage you to complete this form and discuss with your clinician.
If you have questions about this form, please call the number on the back of your enrollee card.

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