• This field is for validation purposes and should be left unchanged.

  • HealthyLife PCP Form Secure Submission

    Upload your completed HealthyLife Biometric Screening PCP Form by 12/31/2026.

    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 following date range: 1/1/2026 – 12/31/2026
    • Be sure to provide a valid email address so we can communicate with you regarding the status of your form.
    • Ensure you and your physician have signed your form. Both signatures are required.







  • Accepted file types: jpg, gif, png, pdf, Max. file size: 50 MB.