ChooseWell

Congratulations on your commitment to “ChooseWell” by completing an annual physical
with your personal health care provider between January 1, 2010 and April 30, 2010.

Please complete and submit the requested information below. You will receive a packet by
mail in 7 to 10 business days to complete and return to KC WELLNESS, INC.

Only Full Time and Regular Part Time E.ON U.S. employees are eligible to participate.

Employee ID:
First Name:
Last Name:
Street Address:
Street Address 2:
City:
State:
Zip:
Phone:

Take me Back

*KC WELLNESS, INC. will not share your information with anyone including your employer.
Your employer will only be notified when we receive your completed packet.
Please contact us at 877-634-1412 with questions.