Employer Forms

Employer Forms


Consent for Treatment
Registration Form

This is our standard consent and registration form that each patient entering our clinic must complete. Download a copy of the PDF and fill it out before you arrive at the clinic for a more speedy check-in process.

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Health History Form

This form is used for most pre-placement physical exams and all injury first visits.

Filling this out prior to your appointment can expedite the check-in process. Download PDF »

Respirator Questionnaire
(Part A)

This is the questionnaire required by OSHA and needed to complete a respirator clearance exam. Employers and employees must fill out the form in its entirety prior to the employee arriving for the exam.

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Service Request Form

This form should be completed by the employer before an employee visits an ExpressMED/BOAC location for an Occupational Medicine service. This form ensures accuracy and efficiency in treating our Occ Med patients.

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DOT Form

This is the standard long form for Department of Transportation (DOT) medical exams.
Download PDF »

Downtown Manchester Injury Poster

This poster can be printed and displayed in conspicuous areas of your business. Intended to inform employees of our Downtown Manchester location if they happen to get sick or injured.
Download PDF »

Manchester Airport Injury Poster

This poster can be printed and displayed in conspicuous areas of your business. Intended to inform employees of our Manchester Airport location if they happen to get sick or injured.
Download PDF »

Salem Injury Poster

This poster can be printed and displayed in conspicuous areas of your business. Intended to inform employees of our Salem location if they happen to get sick or injured.
Download PDF »


Employer Survey

Your satisfaction is always important to us,
please complete and submit one of our employer
surveys to tell us about your experience with BOAC.

Download PDF »