WELL WISCONSIN HEALTH CARE PROVIDER FORM
The health care provider form is used for participants who choose to submit results obtained by a physician.
Completed form is due on or before October 9, 2020 by 11:59pm CST.
Before you submit your form, make sure you:
To submit your form, select Choose File to load your document, then select Upload.
For assistance regarding your health care provider form, please contact US Wellness at (301) 926-6099 x900.