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Medical Authorization Form

Does your business have an established account with Local MD Urgent Care? Fill out the online Medical Authorization Form below!

If you encounter any issues with the form below, email us at OccHealth@Local-MD.com.

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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