Occupational Health Pre-Registration

For each visit to our office please be prepared by bringing the following information:

    • Address
    • Phone number
    • Authorization Form From Employee
    • Photo I.D.
  • Minors:
    • All individuals 17 and under will need parental / guardian consent to be treated. Click here to download the consent form.
    • All individuals 15 and under must be accompanied with a parent/guardian.

For pre-registration form please click here.

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LUTHERAN HEALTH NETWORK
BLUFFTON REGIONAL MEDICAL CENTER | DUKES MEMORIAL HOSPITAL | DUPONT HOSPITAL* | KOSCIUSKO COMMUNITY HOSPITAL*
LUTHERAN HEALTH PHYSICIANS | LUTHERAN HOSPITAL* | MEDSTAT | THE ORTHOPEDIC HOSPITAL* | REDIMED | REHABILITATION HOSPITAL*
ST. JOSEPH HOSPITAL*

*A physician owned hospital.

In case of a life-threatening emergency, call 911 or go to the nearest Emergency Department as soon as possible.