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Health Educator Appointment Request Form

A Health Educator will reach out within 72 hours to schedule an appointment based on your responses below.

This is for Health Education only.
If you are thinking of self-harm, please call 988. If you have specific health needs, please reach out to your primary care provider.
For questions your plan benefits, finding a doctor, or claims
Please contact the phone number on the back of your Humana ID card for questions
1.First Name(Required.)
2.Last Name(Required.)
3.Email Address(Required.)
4.Phone Number(Required.)
5.Preferred Appointment Day
6.Preferred appointment time
7.Reason for appointment(Required.)
8.Please add any other details as to what you would like to discuss (i.e. what health education topics you would like to discuss specifically) - this will help our Health Educators prepare and find resources for you before they reach out.
9.What state do you reside in?(Required.)
10.Humana ID (if you are a Humana member)
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