REGISTRATION & PARTICIPATION – Wellness Foundation

CONGRATULATIONS! YOU'VE TAKEN A POSITIVE STEP TOWARDS
TAKING CONTROL OF YOUR HEALTH!

Wellness Challenge 360° Dates

Thursdays
March 26 - May 14 (no class April 9)
6:00 PM
Sessions will be held at the SPUR in Southampton.
Wellness Coach: Peggy Kraus

The March session will be rescheduled. Dates and location forthcoming.

ONCE YOU'VE REGISTERED AND SECURED YOUR SPOT,
FOLLOW THESE STEPS TO GET STARTED!

Fill out the online forms one week prior to the first class:

Participant’s consent

Liability release

WC 360° Questionnaire

**Contact your doctor for*:**

Signed physician’s consent

TWO prescriptions for blood work: lipid panel and A1C (one for the beginning lab work and one for the completion lab work)

(*Your doctor may require you to make an appointment before signing the physician’s consent form or providing blood work prescriptions.)

Please note that you may NOT attend the first class unless these forms are completed and signed and your labs have been submitted.

Get your blood work done

Remember that fasting is required

Ask your doctor and lab to fax the blood work directly to us at 631-329-3714 or info@wfeh.org

Plan to follow up with your doctor and your lab to make sure they have faxed us your blood work as this is your responsibility, not your doctor’s or the lab’s. If you have a copy of your labs, please feel free to fax them to us yourself.

If your insurance company will not pay for the blood work, we have arranged a reduced rate of $30 per visit with Stony Brook Southampton Hospital (631-726-8250)

Fill out final online questionnaire during week 6

Get final labs done directly following week 6 class

When we receive your completion labs and final questionnaire at least TWO business days BEFORE the session graduation, you will be REFUNDED $50. Please allow 2-3 weeks for processing.