MEDICAL RELEASE FORM
This candidate is required to obtain a physician's release before proceeding with the physical
tests. If you feel it is inappropriate to authorize a full release given the candidate's condition,
simply mark the box indicating this. If further information is needed, please contact our office at
(916) 263-3624 between the hours of 8:00 a.m. to 4:30 p.m. Monday-Friday.
(PRINT PHYSICIANS NAME)
(PRINT EXAMINEES NAME)
and find him/her:
to be free of any medical problems which would restrict participation in
the physical test and therefore give an unrestricted medical release to
continue with the physical testing.
to have medical problems which indicate potential risk in continuing with the
physical testing at this time.
I understand the testing will be administered with a registered nurse or emergency medical
technician present and without a physician, in a non-medical facility.
Phone Number (