Patient Registration Forms

Please use the following link to download the forms you will need for your walk-in visit.

Workers' Compensation

Were you injured at work? You are required to bring the following form with you to your visit.

 

Physical Exam

Bring your physical exam form filled out to save you some time when you check-in.

DOT/DMV Physical

Bring your clinic-specific DMV/DOT physical forms with you to your visit. Recommend having a list of medications and surgical history for our medical provider to review, if deemed necessary in order to complete the examination.  

Medical Release of Information

Use the following form to request your information to be released.

Minor Consent - Informed Consent Authorization (17 years old and younger)

Use the following form to authorize an individual who is not a parent or legal guardian to accompany a minor patient to the clinic for medical treatment.