Forms

In an effort to provide timely service, we encourage you to print the relevant form and complete it before you arrive at Secure Medical Care.

• Registration Forms:

  • English version:
    [MS Word]

  • Spanish version:
    [MS Word]

  • Corporate Registration Form (patient info taken prior to drug screen collections, physical exams, bloodwork)
    [MS Word]

• Business Forms:
  (Print out for employees to complete prior to their visit)

  • Workers' Compensation Request for Claim Number Form:
    [MS Word]

  • Corporate ONE TIME Request Form:
    [MS Word]

  • Worker's Comp ONE TIME Request Form:
    [MS Word]

• Business Procedures:
  (Print out for employees to review prior to their visit)

  • Breath Alcohol Testing Procedure
    English (currently updating)
    Spanish [MS Word]

  • Department of Transportation (DOT) Physical Exam
    English [MS Word]
    Spanish [MS Word]

  • Drug Screening Procedure
    English [MS Word]
    Spanish [MS Word]

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