HealthHelpOhio,
LLC
Pre-Screen Group Health Form
Please print a copy of the 2-page form below for each employee who will apply for coverage as part of your group and have each employee complete one. The information contained in the complete forms is Private Health Information and is used for no other reason than to supply carriers with information they need to asses the risk of your group and provide quotes for you.
If anyone has any questions while completing the form, don't hesitate to contact us at: 440.247.2229 or e-mail at: info@HealthHelpOhio.net. Once completed, you can fax them to: 440.247.8860 .. making sure you supply company contact information. THANKS !
To print the 2-page form, place your cursor on one page at a time and click the Print button.
