RELEASE OF INFORMATION FORMS
ANNUAL WELLNESS QUESTIONNAIRES
Annual Physical Questionaire:– Patients that have commercial insurance (not Medicare or Medicare Advantage Plan)
Medicare Advantage Wellness Questionaire: – Patients that have Blue Cross Advantage, Humana Gold Plus, United Healthcare Advantage, Aetna Medicare Advantage or AARP Medicare Advantage Plans
Medicare Annual Wellness: – Traditional Medicare, Cigna Healthspring, Blue Cross Advantage (out of state), or BlueCare Plus
NOTE: IF YOU ARE UNSURE which form to fill out, please call the office for assistance.