Medical Clearance Form Template - Medical history and examination for individuals age 12 and older. Web evaluation form please fax completed form to 302.777.2111. The surgeon (physician of record) may complete the medical. Web available to all users:
Medical history and examination for individuals age 12 and older. Web available to all users: Web evaluation form please fax completed form to 302.777.2111. The surgeon (physician of record) may complete the medical.