FREE 29+ Sample Medical Clearance Forms in PDF | Word | Excel

The medical clearance form can guide sports players, children and military people to get feedback for their health performance from their physician in order to participate in desired activities. These forms are required by anyone who is participating in the activity with a prior Medical History Form of poor health. They can give consent that they are responsible for risks involved in sports they are participating. After initial appointment, medical clearance is needed in the certain situations.

Medical Clearance Form for Dental Treatment

audubondentalgroup.com

To proceed with dental treatment, this form is required from a Medical Physician. This form will include information about patient’s treatment procedures like simple or deep Cleaning, Radiography, simple or surgical Extraction, Fillings, Crowns, Bridges, Root Canal Therapy, Local anesthetic and other. This form also includes information about patient’s medical condition to give special consideration.

Medical Clearance Form for Surgery

atlantaeyephysicians.com

This form should be completed by the primary care physician. Before the date of surgery, medical clearance is required from the primary care physician. The person can print a copy and take to their primary care physician’s office for them to complete. They must ensure their primary care physician completes it in a timely way.

Medical Clearance Form for Employment

upstate.edu

Purpose of using this form is to ensure that selected employees are physically and mentally fit to execute functions without risk to their own or others health and safety. All staff members may be needed to undergo medical examination to make sure that they stay medically fit to execute functions assigned to them, under certain conditions.

Medical Clearance Form for Exercise

smhfit.com

Using this form, the physician makes it clear if their patient has any unstable medical issues that are a contraindication to participating in resistance-training program or an exercise. They can approve and support their participation in progressive strength, flexibility-training exercise program. They can also discuss signs and symptoms that can make an exercise program unsafe.

Medical Clearance Form for Work

co-broomfield.civicplus.com

Medical fitness of staff members and candidates for employment is determined by reference to their medical status, occupation, and the general situations at the duty station at which they are to work. The availability of adequate medical facilities with epidemiological and environmental factors at the duty station is especially important in this respect.

Air New Zealand Medical Clearance Form

airnewzealand.cn

This form is intended to give confidential details to assess the passenger’s fitness to travel. In case the passenger can be transported, these details will facilitate the issuance of the vital directives. The passenger’s doctor has to use blank ink to answer all the questions in capital letters. They can refer the guidelines.

American Youth Football Medical Clearance Form

senderspediatrics.com

Using this form, the person acknowledges that they are fully aware of the potential risk of participating in the sports whether it is football, cheerleading or dancing. They know these activities may result serious injuries, permanent disability, paralysis and even death. They are ware that protective equipment does not avoid all participant injuries.

Basic Medical Clearance Form

senderspediatrics.com

This form should be reviewed by local council for compliance with state or local statutes. It should be kept on file for 7 years minimum or longer in case of injury. The person should contact local attorney for advice on the maintenance and storage term of this and all such forms.

Blank Medical Clearance Form

argylespartans.net

By using this form, the physician is agreeing that they are not assuming any responsibility of the test battery for the administration. They can indicate using this form that why participation in the fitness training would be unwise for their patient. This form also includes a contact number in case of any questions.

Copat Medical Clearance Form

nccrimecontrol.org

Using this form the person is requesting to take part in Correctional Officer Physical Abilities Test which incorporates aerobic assessments to measure their present physical fitness level. Medical screening will consist of blood pressure and heart rate readings, seeking advice in any limitations that they may have which would stop them from participate.

Child Care Medical Clearance Form

michigan.gov

Using this form, person authorizes medical information release concerning home for purpose of determining their suitability to be associated with care of children. They agree they will be responsible for children’s care in a child care setting up to age of 17. They assure that person caring child will be mentally and physically fit.

Dental Medical Clearance Form

crdts.org

Using this form, the doctor explains that their patient, as part of a clinical board exam, is scheduled for dental hygiene treatment which will include: Dental Prophylaxis, Periodontal Probing and Oral Assessment. They request other physician to evaluate their patient’s medical history and suggest any considerations that should be made concerning scheduled dental hygiene treatment.

Doctors Medical Clearance Form

monashaquaticrecreationcentre.com.au

Using this form, the patient states that they have applied to participate with Active Monash in a progressive exercise program which needs their medical clearance before participation. Clearance indicates that for participation they have no contradictions in a gentle group training session. The person can list any concerns or restrictions including medications.

Employment Medical Clearance Form

unicef.org

This form is enclosed for completion by patient and their physician. They have to return this form with a detailed report of radiologist, outlined in Detailed Administrative Letter. They will be reimbursed for medical examination cost and needed tests up to maximum cost, outlined in Detailed Administrative Letter.

Fitness Medical Clearance Form

aahf.info

Using this form, the doctor authorizes the patient to participate in an exercise or fitness training program. This authorization won’t be valid beyond one year from the date of signature. Without specific written consent of the person, disclosure or release of their health information is prohibited to whom it pertains.

Foreign Service Medical Clearance Form

state.gov

Providing information in this form is vital. This information maybe shared with personnel in Office of Medical Services. Unless secured by medical privacy regulations, details may be made accessible to agencies, for law enforcement and administration intentions whether Federal, state or foreign. More details on Routine Uses for system can be found in Medical Records.

Gym Medical Clearance Form

getfit-personaltraining.com

Using this form, it is stated that patient wishes to start personalized training program. The trainer requires his clients to gain medical clearance before starting their exercise program. They can indicate any medical condition that can interfere with patient’s ability to participate in training program including strength, flexibility, and cardiovascular training and nutritional counseling.

Hearing Aid Medical Clearance Form

ihearmedical.com

Using this form, the person encourages for best health interest to consult a physician to get medical evaluation before purchasing or start using hearing aid. They further states that after completion of medical evaluation they should get this form filled up by physician. They will be responsible for fees in this amount excess.

Jetstar Medical Clearance Form

jetstar.com

This form is used by passengers having health condition and intent to travel on flight. It should be completed by treating medical practitioner ensuring to refer Travel Clearance Guidelines to assure they are fit to travel by air. If it is indicated by Travel Clearance Guidelines further information is needed, they must complete corresponding form.

Lufthansa Medical Clearance Form

lufthansa.com

Details requested in this form will be treated confidentially. It should enable airline’s medical services, as they judge by specific air medical experience under conditions person can be permitted to travel by aircraft. It will help Medical Service in issuing proper instructions for their care which consider their diagnosis and circumstances of requested air journey.

Michigan Medical Clearance Form

joyfulnoisekids.com

Using this form, the person confirms that they have submitted a physical examination copy which physician completed within past six months. They state that they are in good physical health and understand completely that what they trying out for on their free will and that they are responsible for any injuries incurred during such tryouts.

Oral Surgery Medical Clearance Form

warrenoralsurgery.com

Patient’s initial appointment will include a consultation explaining their diagnosis and treatment choices with fee estimates. For minor treatments, surgery can be performed same day as consultation. But, a complex medical history or procedure plan necessitating IV anesthesia will need a second appointment and a more in-depth evaluation to provide treatment on another day.

Pare Medical Clearance Form

policefit.ca

Using this form, person appoints a physician for a medical clearance in order to undergo Pare to become a CBSA officer trainee. They are required to complete PARE medical clearance form with sign, stamp and date and provide original copy to patient and a photocopy of form to keep in patient’s medical file.

Pre OP Medical Clearance Form

drharwin.com

Using this form, physician performs and interprets all diagnostic tests they determine to be vital to clear patient for surgery.  They are required to fax copies of all results and this form to address to attention of Jeanne. They have to notify office immediately, if they find any contraindications to surgery.

Personal Training Medical Clearance Form

recreation.ku.edu

Using this form, person expresses  interest  in  starting  exercise  program  through  Personal  Training  program  at  University  of  Kansas.    Exercise suggestions offered by trainer will start and become more intense based on their goal and fitness level. Periodically, fitness  assessments  will  be  conducted   to  determine  progression including  sub-maximal  aerobic  test,  flexibility,  and  strength.

Surgical Medical Clearance Form

humcmd.net

Using this form, the initial history and physical examination is focused on identification of serious cardiac disorders, consisting of heart failure, coronary artery disease, and electrical instability. Additionally, it can be used to identify presence of preexisting manifested heart disease as it is vital to define disease severity and stability.

Sports Medical Clearance Form

gannett.cornell.edu

Using this form, the person authorizes team physicians, Gannett Health Service providers and certified athletic training staff to disclose their personal health information to discuss their injury/illness and treatments for athletic participation with coaching staff and other athletic staff so that they can make decisions about their ability to compete in athletics.

Employment Medical Clearance Form

sas.undp.org

Return to Medical Clearance Form

swanseaschools.org

Availability of The Forms

There was a time when patients use to search for forms for the purpose of Medical clearance in order to participate in desired activities. But, these clearance forms are now available for any patient online. They can collect these forms in Word or PDF formats. Some patients doubt authenticities of these forms available online; but, they are absolutely error free, downloadable and printable within a matter of seconds. These forms are available in bulk on our website in versions in higher and lower ones. Our expert team can help, if a patient prefers extra customization. Based on requirement, you can use this clearance form by customizing or directly you may also see Medical Claim Forms.

The Medical clearance form helps trainers to obtain knowledge about their participant’s health. The strength of the participants noted by the physician in this form can be used for their benefit. The participants can obtain confidence using this form in preparing for the career and get extra responsibilities for learning.