Physician Form Secure Submission

Submit your completed Physician form by 9/30/2025

The Physician form results will be added to your LIIVeWell 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.

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

• Print clearly and review your form to ensure it is complete
• Confirm the date of the screening is within the program date range: 1/1/2025-9/30/2025
• Provide a valid email address so we can contact you regarding the status of your form
• Only submit ONE form/upload at a time
• Ensure you and your doctor have signed your from- Both signatures are required

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

• Note: Spouses need to create their own LIIVeWell account and employees cannot upload spouse forms into their LIIVeWell account