Welcome

Welcome to Wellsmith! Wellsmith supports patients with a variety of health concerns. This survey helps us understand your health and how Wellsmith can best support you. It should take about 10 minutes to complete this survey. First, we'll need to know a little bit more about you. 

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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/YYYY format.
Example: 01/20/1900

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* 4. Please enter your information below:

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* 5. What is the best way to reach you?

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* 6. Employee Member ID

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