Welcome

Welcome to Wellsmith!  Wellsmith supports patients with Type 2 Diabetes.  This survey helps us understand your health and how Wellsmith can best support you.  It should take less than 10 minutes to complete this survey. 

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* 1. What is your first name (as it appears on your insurance ID card)?

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* 2. What is your last name (as it appears on your insurance ID card)?

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* 3. What is your Date of Birth?  Please enter in MM/DD/YYY format. Example: 01/20/1900

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* 4. Please provide your contact information

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* 5. What is your preferred method of contact?

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* 6. Please enter your mailing address below:

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* 7. Are you a Cone Health Employee, or a dependent of a Cone Health Employee?

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* 8. What is the Cone Health Employee ID associated with your coverage?

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* 9. How did you hear about Wellsmith?

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