Norton Healthcare Occupational Medicine Forms
Norton Occupational Medicine is pleased to offer occupational medicine services to employers in Louisville and surrounding counties, including Southern Indiana. We are proud to have more than 100 years of occupational health experience. Our goal is to help you successfully manage your employees’ health.
For Employers
Thank you for choosing Norton Occupational Medicine. Many services are done on a walk-in basis; however, we do request appointments for physical exams, fitness for duty exams and fit tests. To schedule an appointment, please call or ask your employee to call (502) 559-9675.
Authorization Form – Complete and send this form with your employee or email it to OccMedAuthorizations@nortonhealthcare.org.
Download List of Locations and Map
If you are new to Norton Occupational Medicine and would like to set up an account, complete this form and email it to OccMedInfo@nortonhealthcare.org.
For additional questions, email OccMedInfo@nortonhealthcare.org.
For Your Employees
Thank you for choosing Norton Occupational Medicine. Many services are done on a walk-in basis; however, we do request appointments for physical exams, fitness for duty exams and fit tests. To schedule an appointment, please call (502) 559-9675.
In order to save time at your appointment, please complete the following form.
- Employee Consent for Treatment Form (Complete this form prior to your appointment.)
To keep your wait time to a minimum, please download the appropriate visit packet and bring to your appointment.
- 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.
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