Upload all applicable / completed forms here:

• Health Screening Form

• Flu Verification Form

• Exception Forms
  • Health Screening Exception Form
    • If you or your spouse/domestic partner are unable to complete a health screening or achieve any of the required health metrics (e.g., it is unreasonably difficult, medically inadvisable, or you’re disabled) you may request a reasonable accommodation or alternative standard for consideration.
       
  • Flu Vaccination Exception Form
    • If it is medically inadvisable for you to receive a flu vaccine, you may request an exception for consideration. 
       
  • COVID Vaccination Exception Form
    • If it is medically inadvisable for you to receive a COVID vaccine, you may request an exception for consideration. 

Before you submit your form (s), make sure you:

Step 1: Fill out your information completely and include an email address.

Step 2: Ensure you have signed your form. Without your signature, this form will not be accepted.

Step 3: Ask your doctor to fully complete their section of the form, according to the instructions on the form.

To submit your form(s), complete the Personal Detail fields below. Use the UP Arrow on the right hand side to upload your completed form(s). To submit your details and form(s), click the "Upload Form(s)" button at the bottom of the page. 

For assistance, please contact US Wellness at support@uswellness.com or 301-926-6099 X900.