Forms / What to Bring
For Employees:
Ensure you bring an Authorization Form (from your company) and a picture identification card. Any relevant questionnaires should also be completed, printed, and brought to the appointment. Please complete the highlighted items only. Questionnaires can be found below.
For Employers:
Please provide each employee with an Authorization Form and encourage completion of relevant questionnaires. If you would like on-site services such as flu shots, drug screenings, or physicals at your place of business, please complete the On-site Service Request form below.
Forms & Questionnaires 
- Client Needs Survey – Tell us about your company
- Company Worksheet
- Asbestos Exposure PART 1: Initial Medical Questionnaire
- Asbestos Exposure PART 2: Periodic Medical Questionnaire
- Authorization Form for Examination/Treatment
- Audiometric Exam Questionnaire
- On-Site Service Request
- Physical Exam DOT Questionnaire
- Physical Exam Non-DOT Questionnaire
- Pulmonary Function Test Questionnaire
- Random Program Consortium
- Respirator Clearance Questionnaire