Please click on the tabs below to download forms and to learn more about each section.
- Registration Information Form – FOR ALL PATIENTS
Supplemental Patient Forms
- CDL Medical Certification – DOT Medical Examination Report Form
- OSHA Respirator Medical Evaluation Questionnaire (English)
- OSHA Respirator Medical Evaluation Questionnaire (Spanish)
- Physical Health History Form – for non-DOT physical exams
- Workers Compensation Illness/Injury – Initial visit medical history
What To Bring With You
- Photo identification – all patients and adults who accompany patients under age 18 must have photo identification, such as a driver’s license, passport, military ID, employment badge or student ID card.
- Medical history information – bring information about past surgeries and medical conditions, allergies and current prescriptions.
- Insurance information – bring workers compensation insurance information, including name of insurer, policy number and claim number, for work-related injuries. We ask that patients also bring their insurance card as it may be requested if a referral to a specialist is needed.
- Any forms you have printed and completed in advance. These forms are also available for you to complete when you check in.
- Any forms you need the provider to complete, such as an employer-specific physical form.
Other Helpful Information
- Late arrivals – any patient arriving more than 10 minutes late for an appointment may be asked to reschedule.
- Treatment of minors – a parent or guardian must accompany the minor to all appointments.
- Patients are asked to not bring children with them to their appointment – due to the nature of certain services, for example drug testing and other diagnostic testing, only patients and staff are allowed in the testing and treatment areas. Children cannot be left unattended in the waiting room and the staff at Workplace Health & Wellness is not responsible for their supervision. Patients who bring children to an appointment may be asked to reschedule.