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Biometric Screenings
Onsite Flu Clinics
Community Flu Clinics
Other Services
Drug Testing
Background Checks
Wellness Education & Nurse Coaching
Body Composition Testing
Schedule a Body Composition Evaluation
Health Calculators
Request a Copy of a Form
COVID-19
WPV Nurse Resources
About WPV
Who We Are
What Our Clients Say
contact us
Schedule a Drug Screen
Request Background Check
Home
Biometric Screenings
Onsite Flu Clinics
Community Flu Clinics
Other Services
Drug Testing
Background Checks
Wellness Education & Nurse Coaching
Body Composition Testing
Schedule a Body Composition Evaluation
Health Calculators
Request a Copy of a Form
COVID-19
WPV Nurse Resources
About WPV
Who We Are
What Our Clients Say
contact us
Schedule a Drug Screen
Request Background Check
Form Request
Request a copy of a past screen or flu immunization.
Please complete the form below to request any of the following:
Proof of Flu Immunization
Biometric Screening Results
Other Personal Health Information
Participant Name
*
First Name
Last Name
Participant Date of Birth
*
MM
DD
YYYY
Email
*
Forms will be sent via encrypted email to this address unless specified below.
What type of information are you looking for?
*
Proof of Flu Immunization
Results of Biometric Screening
Other (please indicate below)
Please enter the location of the public flu clinic, or the name of the Employer where the flu immunization or biometric screening was held.
*
What was the approximate date of the flu immunization or biometric screening?
*
MM
DD
YYYY
Delivery
Email (default)
US Mail (list address below)
Fax (list # below)
Include additional information here.
Authorization
Relationship
*
I am requesting this information for myself.
I am authorized to request this information on behalf of the participant.
By entering your name below, you attest that you are authorized to request or receive information on behalf of the participant described above.
*
First Name
Last Name
Thank you!