Clinic & Affiliate Essentials

Clinic

Below are several downloadable forms and questionnaires required by clinics for delivering various treatments and services to employees of AllOne Health clients. If you are unable to locate the desired form, please contact us at 1-800-350-4511.

Occupational Health Downloads

Audiometric History and Result Form
Ergonomic and Musculoskeletal Questionnaire
General Medical Questionnaire (non-exposed employees)
General Medical Questionnaire (Exposed employees, Federally mandated)
Hepatitis A Vaccine Consent
Hepatitis B Vaccine Consent
Medical Information Release
OSHA Respirator Fitness Medical Evaluation Questionnaire
Periodic Medical Questionnaire
Physical Examination Form
Spirometry Form
Tetanus and Diphtheria (TD) Vaccine Consent

Kit Requests

Order Drug Screen Kit
Order Blood Test Kit
Note: only requests from clinics registered with AllOne Health can be fulfilled.

Affiliates (EAP)

Several forms and documents are also available for download by AllOne Health's current and prospective EAP clinical affiliates. Contact us at 1-800-492-0052 if you do not see the form you require.

Current Affiliate Downloads

Formal Referral Affiliate
General Affiliate
Non DOT SAP Affiliate
SAP Affiliate

Prospective Affiliate Downloads

Affiliate Application
Affiliate Contract