California Medical Release FormCalifornia Medical Release Form
Download the document to the computer for easy use
There are more pages to preview,Read on

UNIT 7
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.
have examined

I,
(PRINT PHYSICIANS NAME)
SSN

(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.
Physician Signature

Address

Date

Phone Number (