MyHealthTeam

Member Information

Your information is protected. UPREHS will not release your information to your employer. This information is only being collected to determine your eligibility for the MyHealthTeam program. You must be a non-Medicare UPREHS member to enroll in this program.
Member Gender*
Member Name*

First NameLast Name
Best Contact Number*

Area CodePhone Number
Member Birth Date*

MonthDayYear
Height*
Weight*
Member E-Mail*
Medical History
Have you ever had (Please check all that apply)

AsthmaArthritisCancerDiabetesFainting SpellsHeart DiseaseHeart AttackHigh Blood PressureDigestive ProblemsKidney DiseaseLiver DiseaseSleep ApneaUse a C-PAP machineNeurological DisordersBleeding DisordersLung DiseaseEmphysemaBariatric surgery
Other illnesses:
Healthy & Unhealthy Habits
Exercise

Never1-2 days3-4 days5+ days
Eating Habits

My diet could use some helpI watch what I eatI never diet
Alcohol Consumption

I don't drink1-2 glasses/day3-4 glasses/day5+ glasses/day
Caffeine Consumption

I don't use caffeine1-2 cups/day3-4 cups/day5+ cups/day
Do you use tobacco products or vape?

NoYes
Include other comments regarding your Medical History
Should be Empty:

Member Information