Request Your My Health Youniverse Passport

This data is required to request your health records and for you to access your Health Risk Assessment.  AND to be certain your record doesn't get confused with a similar name or other information. It is ONLY to assist you, and will not be viewed, shared, sold or leased.

Other than your actual street address, it is helpful for us to have ALL of this information but only Name, Date of Birth & Email are required. Cell is super helpful for electronic access.

1. *Last Name, First Name, Middle
2. *Date of Birth, Gender 
3. City, State, Zip
4. *Email - This will become your login
5. Cell Number for Text Notifications Only - No one will ever have access or call you.
6. NO PERSONAL DATA IS EVER STORED ON THIS SITE!
7. Check Your Junk Mail for Email Confirmation