Occupational Healthcare Forms
The following forms and documentation will streamline the service experience for our occupational healthcare clients and their employees.
Company Profile: Your company profile will help make each visit hassle-free and lessen the phone calls to your company or contact person. All of our locations are connected by one computer system, so regardless of the St. John Clinic Urgent Care location you visit, our staff can access information from your company profile.
Employer Authorization to Treat Form: Human resource department or applicable company contacts: Please complete and sign employer authorization to treat form for any patient coming to one of our three convenient locations. This form will be for all first reports of injury or for pre-placement physicals, Department of Transportation (DOT), drug screens or testing. The patient may present this form to the receptionist upon check in, or the supervisor/company contact may fax a completed and signed form to the location where the employee will be sent for treatment.
Patient Information Authorization Form: Every patient must complete and sign a patient information authorization form before their visit. For your convenience, the patient may complete this form in advance and present it to the treating facility upon arrival.
Pre-Placement or Return to Duty Physical: If you request a pre-placement physical or a return to duty physical, please complete this medical history form and present it to the treating facility upon arrival.
Testing Questionnaires and Forms
St. John Clinic Occupational Health Care offers audio, spirometry and vision testing, as well as respiratory medical evaluations.