State of Montana Blood Pressure Management Enrollment Form
11-06-14

THIS FORM WAS DEACTIVED BECAUSE THIS PROGRAM IS NO LONGER SPONSORED BY DPHHS.

Please contact Michael McNamara (444-9170) if you have questions.

The Blood Pressure Management Program includes a blood pressure kit (an automated blood pressure cuff, educational material, a pedometer and a pill box) for self-monitoring. This form is used to enroll State of Montana employees, enrolled spouses and retirees into the Blood Pressure Management Program. All fields are required except: Home Phone and Email.

Once you have submitted the form, your application will be processed within 10 business days. If you do not qualify for the program, you will be notified. There is no-copay to participate in the program.

Approximately six months after receiving the kit, you will be mailed a survey to complete.

This Form is currently Deactivated.

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