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1. Complete Member Information.

MEDICAL FREEZE

• Physician’s note must be received to implement the freeze clearly stating the reason for the freeze with a START AND END date.
• The freeze can start on any day of the month.
• If you wish to return sooner than the physician’s recommendation, they will need to submit another note clearing you for exercise.
• There is no charge for the freeze. If a note is not received, $12 will be charged per month.
• Upload the note here, fax to: 919-545-2687, drop off at DCFL front desk, or email to: [email protected].