Now accepting Telehealth appointments. Virtual Visits are available starting October 19th.

Forms

Industrial Medical Group of Santa Maria Valley Contents Forms

 

Please select your appropriate form from the choices below. If you have any questions, please contact our office at 805-922-8282. 

 

 Employer Treatment Authorization Form - Fill-In

 TB Questionnaire - Bilingual

 Respiratory Questionnaire Bilingual

 New Account Information Form

 Account Information Update

 CPR and First Aid Training

 Medical Examination Report

 Medical Examination Report (Spanish Version)

 Travel Medicine Questionnaire

 Basic Health Screening Questionnaire

 Patient Information Form

 IMG WC Injury Patient Form

What we offer

Services

 
Location
Industrial Medical Group of Santa Maria Valley
3070 Skyway Drive, Suite 106
Santa Maria, CA 93455
Phone: 805-922-8282
Fax: 805-925-2690
Office Hours

Get in touch

805-922-8282