BestHealth Membership Application

Last Name   
First Name  
Middle Initial  
Maiden Name  
Address  
City  
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Home Phone  
Daytime Phone  
DOB (MM/DD/YYYY)  
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Gender    
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Race
If other, please specify:      
Employer  
Do you have health Insurance?     
Insurance Company    
Name and location of primary care physician  
Which hospital do you prefer to use?  
Today's Date    [None] Select a Date Delete the Date

Health Interests
To select more than one interest,
hold down CTRL and click.

 

 

By enrolling in BestHealth, you will be added to the BestHealth and Wake Forest Baptist Health mailing list.
The information provided by BestHealth is not intended as medical advice or as a substitute for consultation with a physician.

 

 

Quick Reference

BestHealth
Questions?

336-713-BEST
336-713-2378

bhealth@wakehealth.edu

Registration

336-713-BEST
336-713-2378

Ways to Give
USNWR 2013-2014Magnet Hospital RecognitionConsumer Choice2014 Best DoctorsJoint Commission Report

Disclaimer: The information on this website is for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, evaluation or care from your physician or other qualified health care provider.