Patient Forms & Documents

Please print forms single-sided only.

• After Hours Urine Drug and Alcohol Collection (PDF)
• Authorization to Release/Receive Medical Records
• Random Drug & Alcohol Program Change Form (PDF)
• Medical History Comprehensive (PDF)
• Influenza Vaccine – Consent to Receive Form (PDF)
• Flu Facts ENGLISH (PDF)
• Flu Facts SPANISH (PDF)
• Audiometric History Form (PDF)
• Audiometric Testing and Training Form (PDF)
• OSHA Respirator Medical Clearance Evaluation (PDF)
• Worker’s Compensation Worksheet
• Authorization for Medical Services Form (PDF)

Carroll County Volunteer Fireman’s Association Documents

• CCVESA Authorization for Medical Services Form (PDF)
• CCVESA Packet
• Carroll County Volunteer Fireman’s Association – Parental Permission Form (PDF)

Lisbon Volunteer Fire Company Documents

• Lisbon Volunteer Fire Company Exam Packet (PDF)
• Lisbon Volunteer Fire Dept Parental-Permission Form (PDF)

Howard County Fire & Rescue Documents

• Howard County Fire and Rescue Combined Physical Packet (PDF)
• Howard County Fire and Rescue Parental Permission Form (PDF)