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Medical Authorization Form

Does your business have an established account with Local MD Urgent Care? Download our Medical Authorization form below and then upload the file and click "Submit

If you do not have an account with us, email OccHealth@Local-MD.com before completing the form.

Patient Information

Work-Related Injuries

Evaluations / Examinations

Drug & Alcohol Testing

NON-NIDA* / NON-DOT**

Drug Testing
Alcohol Testing

NIDA* / DEPARTMENT OF TRANSPORTATION

Drug Testing
Alcohol Testing

*National Institute on Drug Abuse

**Department of Transportation

Other Services

Thanks for submitting!

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