For Your Employees

Complete these forms and send with your employee, or you may email  to occmedauthorizations@nortonhealthcare.org or fax to your preferred Norton Occupational Medicine location. Call or have your employee call (502) 559-9675 to make an appointment.

• Employee Consent Form – Complete this form or have your employee complete to electronically consent to being treated or evaluated.
• Employee Authorization Form: Complete this form or have your employee complete it and bring with them to the appointment.

Download the appropriate visit packet and bring to the appointment. These forms are also available during the visit.

• Audiometry (hearing) test
• Confidential Animal Handlers’ Medical Surveillance Questionnaire
• Day care physical – Indiana
• Department of Transportation (DOT) exam
• Indiana Department of Revenue sleep apnea form
• Injury evaluation
• Non-DOT physical exam without OSHA respiratory questionnaire
• Non-DOT physical exam with audiometry
• OSHA respiratory questionnaire
• Physical exam with OSHA respiratory questionnaire
• Tuberculosis (TB) positive reactor exam

Click for a list of Norton Occupational Medicine locations.