Preventative Health Initiative Payroll Document Upload

The upload feature on this page is HIPAA compliant and encrypted. Please follow the Payroll Report Guide below and upload the necessary payroll documents.

Payroll Report Guide

We need the most recent month's payroll reports. Each report needs to be pulled by Individual Pay Cycle

We require payroll reports to include ALL of the following:

- First Name
- Middle Initial
- Last Name
- Gross Pay, by pay period, for the most recent months' pay
* This should not include bonuses, commissions, overtime, etc. Regular Gross Pay Only.
- All Pretax Deductions
* Including Health and Medical, retirement contributions (dollar amount) and any other Pre-Tax Deductions
- Pay Frequency - weekly, bi-weekly, monthly

Please use the same information as used when submitting intake form. This ensures that the documents will be connected to your file immediately.

When preparing your payroll documents, please upload all necessary documents before clicking submit.

First Name *

Last Name *

Email *

Business Name *

Referring Agents Name *

Payroll Documentation *

Notes *

I agree to by providing my phone number, I agree to receive text messages and phone calls from the business.