Annual Wellness Visit

Annual Wellness Visit Form

pdf icon

PDF document
Requires Adobe Reader software

An important step in health maintenance is for you to work with your primary care physician to assess, on a yearly basis, your health and wellness.

Medicare and most health insurance programs cover one wellness visit each year.

» View our guide to Medicare's preventive care coverage.

Some of the major areas addressed during the annual wellness visit are:

  • Personal health history.
  • Social history.
  • Recent or significant symptoms.
  • Family health history.
  • Personal safety.
  • Mental health.
  • Health habits (alcohol use, tobacco use, diet, exercise, etc.)

Getting Started: Three Simple Steps

  • Step 1: Make appointment with your Primary Care Physician for your annual wellness visit. Be sure to use these exact words so the appointment is scheduled correctly.
  • Step 2: Before the wellness visit, please download and complete the Annual Wellness Visit / Health Risk Assessment form offered above. Completing the form can help you get the most out of your visit. The questions are based on years of medical research and advice from agencies and organizations such as the Centers for Disease Control and Prevention (CDC) and the U.S. Preventive Services Task Force.
  • Step 3: Be sure to take the completed form with you to the annual wellness visit.