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.
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Medical Care Poster

This poster can be printed and displayed in conspicuous areas of your business. Intended to inform employees of all 3 locations if they happen to get sick or injured.
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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 »