Forms

  • Vitality Check Form
    • Submitting this form will meet the following wellness requirements:
      • Primary Care Provider Visit (Section C)
      • Biometrics screening (Section B); blood pressure, height, weight, fasting glucose and lipid panel are required. All other fields are optional.
    • Please submit a completed form directly to Vitality and bestlifewellness@crmcwy.org. Incomplete forms can also be submitted to bestlifewellness@crmcwy.org for safe-keeping until you are ready to complete it and submit it to Vitality. Please contact Wednesday Storm, Employee Health and Wellness Nurse for any problems with the submission process.
  • GINA Authorization Form 2020
    • Must be completed by spouses to be able to participate in the wellness program. Please send completed forms to Wednesday Storm, RN.
  • ADA Wellness Program Notification
    •  Participant rights, protections and alternatives for the Wellness Program.