GPC Wellbeing 2026 |

Preventive Care Submission Form

For each preventive care activity you complete:

Select the appropriate activity type.
Complete all required fields.
Upload your supporting documentation.

Preventive care activity type(Required)

Healthcare preventive screening

Enrollment in one of GPC’s Health Management Programs

Enrollment in Rx Savings Solutions

Dental preventive care visit

Vision preventive care visit

Name(Required)

First Name Last Name

6-digit employee ID(Required)

Email(Required)

Supporting Documentation(Required)

To complete your submission, you must provide the required supporting documents. Click here to view the list of supporting documentation examples.

Please remove or black out all financial details and personal health information before submitting.

Upload Steps

Click the “Choose file” button.
Select your document from your device. Acceptable file types include:
- PDF (.pdf)
- Word documents (.doc, .docx)
- Images (.jpg, .jpeg, .png)
Click "Upload" to complete your submission

Accepted file types: jpg, jpeg, png, pdf, doc, docx, txt, Max. file size: 50 MB.

Submitting all required information ensures you receive full credit. Once your documentation is received, you will get a confirmation email from [email protected] at the address you provide.