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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

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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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