HealthiestYou Enrollment-USW

HealthiestYou Enrollment

HealthiestYou is a healthcare service that offers convenient, confidential access to quality doctors and providers by phone, video, or app 24/7/365. This is a service provided to USW students at NO EXTRA COST. Fill in your details below to enroll.

First Name

Last Name

Student ID

Phone Number

Address

Date of Birth

Gender

Spouse/Dependent Information

List the following information about each spouse/dependent (separated by commas): First & Last Name, Relationship to You, Gender, Date of Birth

Spouse/Dependent #1 Information

Spouse/Dependent #2 Information

Spouse/Dependent #3 Information

Certification

I authorize USW to use the above information to enroll listed names in the HealthiestYou telehealth service.

Your Signature

After submitting this form and once enrolled, you will be notified via the email you provided. The email will include the next steps in order to complete the registration process with HealthiestYou. Enrollment is usually completed within 72 hours, but on rare occasions, could take longer.