Patient Forms

Before visiting our office for your DOT physical, please download the patient registration form and the DOT medical history-examination form below, and complete them prior to your visit. This procedure will make your office appointment more time efficient. If you cannot download these forms, or cannot complete them prior to your visit, they will be provided at our office. Please arrive 30 minutes prior to your appointment time to allow ample time for completion of forms.

Medical Examination Report

Patient Registration Form

Our Location

Merrillville Office Center 6111 Harrison St., Suite 211 | Merrillville, IN 46410

Office Hours

By Appointment Only

Monday:

5:00 pm-8:00 pm

Tuesday:

5:00 pm-8:00 pm

Wednesday:

5:00 pm-8:00 pm

Thursday:

5:00 pm-8:00 pm

Friday:

Closed

Saturday:

8:30 am-3:00 pm

Sunday:

Closed

Contact Us Today!

We look forward to hearing from you.