Printable Forms for Employers and Employees
Employee/Patient Forms

English and Spanish forms are available here to fill out prior to your visit. Save time by having them completed & ready when you check-in.

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Injury Forms

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Health Questionnaire - English or Spanish

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Injury Questionnaire

(Questinario de Accidente)

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Authorization for Release of X Rays and Medical Records

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Consent to Release Medical Information

(Consentimiento Para Traspasar Informacion Medical)

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Misc. Forms

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Audiometric Evaluation Record

(Registro de Evaluation Audiometrica)

 

OSHA Recommended Questions for Respirator Evaluations - English or Spanish

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Seasonal Influenza Vaccine Consent Form

Physicals and Screenings

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Drug/Alcohol Screening Consent Form - English or Spanish

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Pre-Placement Physical Consent Form - English or Spanish

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Consent to Release Medical Information

(Consentimiento Para Traspasar Informacion Medical)

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ALL PATIENTS/EMPLOYEES

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AUTHORIZATION AND REQUEST FORM