Annual Wellness Visit Request

Annual Wellness Visits are visits that focus on gathering your health information and counseling you on improving your health and wellness.    It is for preventing complications from any illness you may currently have and creating a personalized prevention plan for years to come.

  • This is not the same thing as a yearly physical exam, but screening services could be ordered.
  • Medication reconciliation will occur prior to the visit.
  • Your healthcare team might refer you for screenings or referrals outside of your appointment.

Most insurance plans including Medicare and Medicaid will pay 100% of your Annual Wellness Visit.  There will be no deductible or co-payment for the Annual Wellness Visit.  If screening services occur, there may be a deductible or coinsurance depending on your insurance.

If you would like more information about our Annual Wellness Visit Program, see if you qualify or would like to set up an appointment, please fill out the below information and one of our staff will contact you at the best available time for you.

Annual Wellness Visit Registration Form
Patient Name:*
Are you an existing patient?
Date of Birth:
 / 
 / 
Phone:*
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Best Day & Time for a returned call:
Any questions or concern: