Skip to main content
Text:   Larger - Smaller  | Translate
Incentives
Calendar
Wellsteps
Newsletters
  1. SLCo
  2. Healthy Lifestyles
  3. Forms
Menu

Forms

How to Turn in Your Forms

NEW!: You will no longer submit medical forms if you are enrolled in SLCo's health plans (Select Health, PEHP, Cigna).  To earn credit for these wellness visits you will need to complete the PHI consent form:

  • For Employees, Spouses/Adult Designees: sign this form and email to Myhealthylifestyles@slco.org or send via courier: Attn-Healthy Lifestyles, GC S2-600-4575

Please read this PHI FAQ for more details about why you are being asked to consent.

*If you are not enrolled in a County medical plan, you can still earn credit for your wellness exams. We can accept either your signed Healthy Lifestyles form or your Explanation of Benefits statement. 

You can submit proof in any of the following ways:

  • Via WellSteps: Upload as an attachment to the activity
  • Email: Scanned and emailed to MyHealthyLifestyles@slco.org. You can also take a picture of your form or EOB on your phone and email it directly. 
  • Courier: Attn-Healthy Lifestyles, GC S2-600-4575
  • Fax: 385.468.4096
  • Drop Box: Located outside the HealthyMe clinic at S2-500

*Remember your forms must be turned in a minimum of 7 days before your scheduled biometric screening. We are not able to accept any forms at your appointment.*

Medical

  • Medical Exam Form Earn points by receiving recommended exams listed on this form. Points vary based on type of exam. If you forget this form, we will also accept other proof from your doctor's office.
  • Flu Shot Form (25 pts)
  • Follow-up Form (100 pts): If your cholesterol was above 200 or blood pressure was above 120/80, receive 100 points for having it checked by your doctor.

Classes

  • Health Class Form (150 pts): Contact Healthy Lifestyles to see if you are eligible, email: MyHealthyLifestyles@slco.org.
  • Tobacco Cessation Class Form (150 pts)
  • Living Well With Chronic Conditions Class (150 pts): Learn to live well with your chronic condition, alongside your caregiver, and/or spouse. Free classes are held throughout the valley. .To receive credit, submit a copy of your certificate of completion to Healthy Lifestyles using one of the suggested methods in "How to Turn in Your Forms" (above).

Other