Together, we’re helping you stay well. Here’s your FREE Walgreens Health Test voucher!* When redeeming this offer, please follow these simple steps: 1. Fasting is not required. For the best results for the full cholesterol panel test, fasting for 9 - 12 hours of no food or drink (other than water) is an option, unless advised otherwise by your physician. 2. Have your health tests performed at a Walgreens pharmacy. Appointments are required. If a same day appointment is requested at the pharmacy, please call ahead to confirm. To schedule your health tests, visit Walgreens.com/schedule. On the left choose Pharmacy. Once in the scheduler tool, check Wellness Pack. 3. At your Walgreens pharmacy, in order to get tested and receive credit for your incentive, you must present the completed voucher below and a photo ID at the beginning of your visit. This voucher entitles the bearer to receive the following health tests at no charge: one Blood Glucose Test, one Full Cholesterol Panel Test and one Blood Pressure Test, plus height, weight, BMI and waist circumference.* Walgreens instructions: • Ensure patient information on voucher is completed and matches photo ID. • Obtain signed authorization for Release of Information (ROI) form. NOTE: This vendor will not pay for service without signed ROI. • If unable to obtain signed ROI form, advise patients they can proceed with the health testing through the normal cost channels (e.g., cash payment). • Use the promotion code MWWA. Scan bar codes on Patient Responsibility Estimate (PRE). • Use the Premera Member # for the Health Testing ID. • Please staple used vouchers to patient consent form. A wellness benefit brought to you by Metallic Wellness Program. Information below must be completed prior to receiving your tests. Please print legibly. Patient Name: Date of Birth: (MM/DD/YYYY) Premera Member # Promo Code: MWWA *Tests are available to ages 18 and over at select Walgreens pharmacies during pharmacy hours. Subject to availability. Limit one per person per enrollment year. No purchase necessary. Nontransferable. Reproductions of this voucher are void. Test results are not for diagnostic or treatment purposes and are not conclusive as to the absence or presence of any health condition. Recipients are encouraged to report test results to their primary care provider. Pharmacist consultation with patient does not constitute medical advice. 030002 (11-2014) An Independent Licensee of the Blue Cross Blue Shield Association 13HT0100