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Request for Corporate Wellness

In order to provide your company with a BeneFIT Corporate Wellness Proposal,
please complete the information requested below:

NOTE: Fees may apply, although some companies may be eligible for FREE or discounted wellness services.

  Group Information:
Items in bold are required.
Group Name:
    SIC Code or Nature of Business:
Contact Person:
   Email Address:
Address 1:
    Address 2:
City:
    County:
State:
   Zip:
(Ex. xxxxx or xxxxx-xxxx)
Phone:

(Ex. xxx-xxx-xxxx)
    
Total Number of Employees:
    
Effective Date of Health Insurance:
(Ex. mm/dd/yyyy)
 /  /
 
Current Health Insurance Carrier (select all that apply):






How did you learn about BeneFITSM?
(Example: broker, billboard, newspaper, radio, chamber of commerce, etc.)
Please indicate the status of your company’s current wellness program. 



Once you have completed this Request for Corporate Wellness, please submit electronically via the SUBMIT button, fax to 610-969-0439 or mail to Valley Preferred, Corporate Wellness, 1605 N. Cedar Crest Blvd., Suite 411, Allentown, PA 18104. A Valley Preferred representative will contact you to review the BeneFIT corporate wellness services and the packages available to help your company on its Way to Wellness.

©2013 Valley Preferred
610-969-0480
1-800-955-6620
1605 N. Cedar Crest Blvd, Suite 411
Allentown, PA 18104-2351

©2013 Lehigh Valley Health Network
610-402-CARE
Toll Free: 1-888-LVH-CARE
Cedar Crest & I-78, P.O. Box 689
Allentown, PA 18105-1556

VALLEY PREFERRED is part of Lehigh Valley Health Network, which includes three full-service hospitals in Allentown and Bethlehem, Pa., community health centers in eight counties, primary care and specialty physician offices throughout the region, pharmacies, imaging services, home health and hospice, community clinics, lab services and preferred provider services.

Lehigh Valley Health Network: Health Care Services | Lehigh Valley Physician Group | Lehigh Valley Home Care | Lehigh Valley Hospice | Health Spectrum Pharmacy Services | Lehigh Valley Magnetic Imaging Center | Health Network Labs | Valley Preferred


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