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Patient & Employer Forms

Please send the completed forms to occmed@nwmedicalgroupwa.com

Patient Information Forms

  • New Injury Intake FormThis form provides more information about your employee's injury. Please complete this and the patient information form and bring it to your visit.

DOT Physical Forms (CDL)

  • Insulin-Treated Diabetes Mellitus Assessment FormCommercial drivers with insulin-treated diabetes need to have this form completed by their treating clinician no more than 45 days before examination by a certified medical examiner. This form is required before a Medical Examiner's Certificate Form can be issued to a certified driver. 

Employer Forms

  • Authorization for Services Form -This form must be returned to us at least one day in advance so that we can ensure we have the necessary supplies to provide services.  This form authorizes us to perform other services, such as pre-employment physicals and drug screens.​

Referring to Northwest Medical Group

  • Referral Request FormPlease complete this form to refer your patient to us.  Once completed, kindly fax the form and medical records to 509-380-9591.​

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