Thank you for filling out the Initial Health Assessment.

Please be sure to submit this assessment for all members of your health plan, including the primary subscriber (you), your spouse, and dependents.

If you need to make corrections in your assessment or need to submit for another member, click here to start over with a new Health Assessment Form. After submission, copies of the Health Assessment are NOT cached, stored, or saved on this server.

A PDF copy of your submission has been sent to the email you provided and our Care Coordination Team. In your email, this assessment will be sent as an attachment.

If joining our One Medical program, be sure to (1) complete and submit an assessment for ALL members over 18 years old entering One Medical and (2) visit this One Medical activation website.