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. 

​

​