Medical History Verification Form 2019

Medical History Verification Form

Please download the Medical History Verification Form by clicking on the link above. Once downloaded, send the form to your provider to be completed and signed. Then, you can upload the completed and signed form in your application or you can send it to The Samfund and we will upload it for you. If you need to fax a form to us (at 1-866-496-8070), or need us to upload a form for you, please be sure we have received it by February 8, 2019 in order to guarantee it will be uploaded in time for the deadline. You may send it after that date, but we cannot guarantee it will be uploaded in time, so please start early!