Physician Affidavit Form

  • Attention ALL Full-time Employees! Complete your physical, have your doctor sign a Physician Affidavit form, and receive a $50.00 gift card! If your spouse gets a physical, they are eligible to receive a $50.00 gift card, too!

    If you have completed your physical any time between January 1 and December 31 of the current year:

    1. Click on the link below
    2. Print out the form
    3. Have your physician certify and sign.
    4. Submit the form by email following the instructions at the bottom of the form. 

You’ll receive an email confirmation upon receipt of your form and your $50.00 gift card will be mailed to your address on file within 45 days of your confirmation. 

The deadline to submit the Physician Affidavit Form for the current year is December 31.