Please complete the following for your Appointment:
- Intake &HIPAA: Please complete for all appointments
- Respiratory Questionnaire: Please complete for respiratory physicals
- Hearing [Audio]: Please complete for any hearing testing.
- DOT: Fill out pages one and two down to the Driver Signature box.
For your DOT Appointment:
Medications: Please bring a list of all medications you take.
Diabetic: You will need an A1C in the last 3 months. If you do not have one, we can draw one onsite for a fee.
Sleep Apnea: A compliance report showing at least 30 days of use.
Heart Stents / Heart Attack / Angina / Bypass: Copy of current stress test as well as bring a medication list.