Physician Referral Form

Please check all that apply:

Drug Testing

Instant Urine Drug Test
Urine Drug Test
Hair Drug Test
DOT Drug Test
Breath Alcohol Test

Physical Exams

Pre-Employment Physical Exam
Pre-Deployment Physical Exam
Immigration Physical Exam
DOT Physical Exam
Annual Well-Being Exam
School Physical Exam

Vaccines

Hepatitis A
Hepatitis A/B
Meningococcal
Pneumonia
Rabies
Varicella
Yellow Fever
Typhoid IM
Hepatitis B
Influenza
MMR
Polio
TD/TDAP
Shingles Vaccine
Typhoid Oral
Japanese Encephalitis

Blood Work

Hepatitis A Titer
MMR Titer
Varicella Titer
Hepatitis B Titer
Rabies Titer
Quantiferon Gold (TB Blood Test)
Blood Type
Complete Metabolic Panel
Liver Function
CBC
Lipid and Glucose
Basic Lipid Panel

Travel Services

Hepatitis A Vaccine
Hepatitis B Vaccine
Hepatitis A/B Vaccine
Influenza Vaccine
Japanese Encephalitis Vaccine
Meningococcal Vaccine
MMR Vaccine
Pneumococcal Vaccine
Polio Vaccine
Anti-Malaria Prescriptions
Travelers Diarrhea Prescriptions
Altitude Sickness Prevention Prescriptions
Travel Medicine Consultation
Yellow Fever Vaccine
Cholera Vaccine

Other Services

Audiometric Test
Eye Exam (Titmus)
Lift Test
OSHA Respirator Questionnaire Review
PFT (Spirometry)
EKG
Biometric Screening
Needlestick Protocol (Bloodborne Pathogens)
Flu Shot Clinic (Seasonal)
Sleep Study
INS Exam
INS Vaccines Only
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Really helpful and friendly staff. E7 helped us schedule and complete the required testing to return to Canada. Thank-you!!

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