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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering the patient's name in the designated field where it states 'I certify that ____________'. This is crucial for identifying the individual for whom the clearance is being requested.
  3. Fill in the date of the most recent office visit and labs. Ensure accuracy as this information is vital for assessing medical standing.
  4. Indicate whether lab results are normal or abnormal. If abnormal, specify which levels are affected in the provided space.
  5. If there are any prescribed treatments for abnormal results, detail them clearly in the corresponding section.
  6. Complete the EKG section by noting if it was normal or abnormal, and provide any necessary details.
  7. List any restrictions or recommendations regarding diet, exercise, work, or other activities as applicable.
  8. Confirm your availability for consultation by selecting YES or NO and providing your contact number.
  9. Finally, ensure you sign and date the form at the bottom before submitting it through our platform.

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Basic Evaluations: Without tests, it may take up to 12 days. Comprehensive Clearances: If lab tests or imaging studies are required, may take several days.
Obtain Physical Examination: Obtain a physical exam for you and any accompanying EFMs from a licensed provider (i.e., a Physician Assistant, Nurse Practitioner, Doctor of Medicine, or Doctor of Osteopathic Medicine), who must complete and sign the DS-1843 /DS-1622 forms.
How you make your request will depend on your providers processes. You may be able to request your record through your providers patient portal. You may have to fill out a form called a health or medical record release form, or request for accesssend an email, or mail or fax a letter to your provider.
This medical clearance form allows clinicians to permit physically and mentally healthy individuals to undergo certain procedures or activities. It includes details capturing relevant information such as health summary, restrictions or special needs, and the doctors certification.
A Medical Clearance Form is a document that certifies an individuals medical fitness for a particular activity or procedure. It usually includes a health history review, physical examination, and medical tests to ensure the patient is healthy enough to participate in the activity or undergo the procedure.

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