Baird Health Care Provider Form

  • Health Care Provider Form Secure Submission

    Submit your completed Health Care Provider Form by 5 PM CT on September 20, 2025.

    Biometric screening results will be added to your B\Well account within 10 business days. If additional information is needed, you will be notified by email. If your form is approved, you will be notified by email. Log in to your B\Well account and explore the Rewards section to review your screening options.

    Before you submit your form, please complete the following steps:

    • Print clearly and review your form to ensure it is complete
    • Confirm the date of screening is within the program date range: 9/21/2024 - 9/19/2025
    • Provide a valid email address so we can contact you regarding the status of your form
    • Ensure you and your doctor have signed your form – Both signatures are required

    Contact WebMD Customer Service at 888-343-9861 with questions.







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