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HealthWorks Forms



The forms below are PDFs that can either be completed electronically or printed out and completed by hand. Whichever way you choose, please bring a hard copy of the completed form(s) with you to your appointment.

Registration Form
All visits require that this form be completed and brought to HealthWorks at the time of your appointment.

Medical History Form
This form needs to be filled out and brought with you to your scheduled pre-employment physical.

Respirator Medical Evaluation Questionnaire
This is an OSHA-required respirator questionnaire that needs to be completed prior to wearing a respirator on the job. Please complete the form and bring it with you to your appointment.

Asbestos Exposure Questionnaire
This OSHA-required questionnaire needs to be completed by all who are exposed to asbestos above the permissible exposure limit. Please complete the form and bring it with you to your appointment.

DOT Medical Examination Expectations
A summary of what to expect at your DOT examination and how to be prepared for a successful outcome

19A Medical Examination Expectations
A summary of what to expect at your Article 19A Bus Driver examination and how to be prepared for a successful outcome