Submit a Resource Request:

Complete this form to submit your resource request. Your resource will be forwarded to the administrators for review and approval before being posted to the Wellmark Health and Wellness Resource Guide.

Submitting a resource does not guarantee it will be approved for the Resource Guide. Wellmark administrators review each submission for accuracy and appropriateness.

Fields with an asterisk (*) are mandatory.

Resource Submitted By
(This information will not be displayed with the resource.)

*First Name:

*Last Name:

*Email:

*Phone:

Resource Information

*Resource Business Name:

Address 1:

Address 2:

City:

State:

ZIP/Postal Code:

County:

Contact Name:

Phone:

Email Address:

Website Address:

*Resource Category(s):

*Resource Description: