BEST RESULTS WILL BE OBTAINED BY OPENING THE FORM ON A COMPUTER - NOT A SMARTPHONE OR TABLET.

INSTRUCTIONS:

  1. Customer information form will open in a new window as a two-page .PDF that can be filled-in.
  2. Use the TAB key to move from field to field until Page 1 is complete.
  3. Scroll to the bottom of Page 2 and click the PRINT FORM button.
  4. Button may not function in all browsers - Use normal PRINT commands to print the document.

AFTER PRINTING:

On Page 1:
  1. CHECK One (1) box in Group 1 & One (1) box in Group 2 to indicate the valid ID you will be using.
  2. CIRCLE One (1) choice in each category in the section at the bottom of the page.
On Page 2:
  1. Read each item and INITIAL the corresponding box.
  2. SIGN & DATE the form at the bottom.

BRING THE COMPLETED FORM WITH YOU TO YOUR MOBIL LIFESCAN FINGERPRINTING APPOINTMENT.