The following forms can be filled out prior to your appointment in order to help save you time.

Print the appropriate form, fill it in and bring it with you to your appointment.

  • General Medical Questionnaire – we require this form to be filled out by all patients being seen for physical examinations or work injuries.
  • Travel Medicine Questionnaire – this form is filled out by patients being seen at our office for travel medicine consultations.
  • OSHA Respirator Questionnaire – this form is filled out by patients being examined for respirator clearance examinations.
  • DOT Exam Form – patients undergoing Department of Transportation (DOT) medical examination should fill out the first page of this form and bring the entire form to the exam appointment.
  • Employer Authorization to Treat – employers may fax this form to the appropriate Pivot Occupational Health office or send it with their employees in order to authorize Pivot Occupational Health examination or treatment services.

COVID-19 Update: We Are Here for You!
All 12 of our Occupational Health clinics are OPEN and offering COVID-19 antibody testing.