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Pre-employment Physical Form - Hutchinson Clinic 2026

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The document is a Pre-Employment/Job Placement Medical Questionnaire designed for prospective employees to disclose their medical history and current health status. It includes sections for personal information, a series of health-related questions regarding past and present medical conditions, and a physical examination report by a physician. The purpose is to assess the individual's fitness for the job applied for and to identify any potential health issues that may affect their employment.

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Click ‘Get Form’ to open the Pre-employment Physical Form in the editor.
Begin by entering your personal information at the top of the form, including your name, date of birth, age, sex, and address. This section is crucial for identifying you as a prospective employee.
Next, provide details about your family doctor and the job you are applying for. This helps establish a connection between your medical history and potential employment.
Carefully answer all health-related questions regarding past medical conditions and reactions. Use the 'Y' or 'N' options provided to indicate your responses accurately.
In the final section, review your answers and sign to confirm their accuracy. Ensure that you also note any additional comments or clarifications required by the physician.

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