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Forms

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Questionnaires

Forms and Questionnaires

Commercial Driver Medical Certification Examination Form
Influenza Vaccine Patient Questionnaire
US Coast Guard Application for Medical Certificate
Initial Visit Forms
Occupational History Form
Health History Form
City of Seattle Respiratory Protection Questionnaire
(City of Seattle Employees Only)
OSHA Respiratory Questionnaire

The Work Clinic has been a local provider of occupational medicine around the Puget Sound area since 1991.

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Contact Information
  • Medical Dental Building 509 Olive Way, Suite 201 Seattle, WA 98101
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  • (206) 995 8868
Contact Information
  • Riverton Medical Building 13030 Military Road South, Suite 100 Tukwila, WA 98168 (206) 243 9675
  • Contact Us
  • (206) 243 9675

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