FREE 30+ Medical Clearance Form Samples in PDF | MS Word

Acquiring a clearance may not always be an easy task to do especially if an individual has observed complications which may hinder the phase of claiming the clearance. With regards to obtaining medical clearances, an individual has to engage in a physical examination, a fitness test, and even answer a set of medical questionnaire forms. This process is required to assure that the condition of the requesting individual will be studied, verified, and determined by the licensed physician who is responsible for indicating his health verdict about the status of the individual.

Blank Medical Clearance Form

Medical Clearance Authorisation Form

Student Medical Clearance Form

Examples of Medical Clearance Forms

The significance of using a medical clearance form is to highlight and state the medical condition of the patient. This document is used whenever a patient is requesting for a medical treatment or participating in a program for curing his illness. By presenting an approved medical clearance, the patient will be granted a permit to participate or continue with his desired activities. Below are some of the basic examples of a medical clearance form:

Athletic Medical Clearance Form – Athletes who have been involved in an incident and have acquired injuries are the subjects of this form. Their legal guardian and licensed physician are the people who will complete the form. This document states the basic data of the student-athlete, the severity of his or her condition, and the suggestion of the physician of whether the athlete will be recommended to return to the games or should remain in his or her bed for a particular duration. The physician is also expected to include the treatments that he or she will require the athlete to take for him or her to be cured faster.

Athletic Medical Clearance Form

Club Medical Clearance Form – Elite and premium clubs require memberships from their regular clients and attendees to record their identities and to promote effective security within the premises. The requirements for their club membership application will highly depend on the type of environment and activities in the club such as a medical history and activity profile form for wellness-related clubs and groups.

With the stated requirements, the management of the club aims to assure that the health risks claimed by their members are true by means of validating the statements from a licensed physician and by requiring the member to submit a club medical clearance upon fulfilling the registration process.

Club Medical Clearance Form

Counseling Medical Clearance Form – When an individual has a mental disorder, he or she is often sent to a counselor or a care institution where he or she may be cured. If the choice of his or her legal guardian is to hire a licensed counselor and have him or her as an outpatient, his or her guardian must also assure that he or she is medically stable to participate well in the sessions provided by the counselor. His or her vital medical information is recommended to be stated by the patient’s physician on a counseling medical clearance form to let the counselor determine if the patient will be able to gain benefits in taking the counseling course.

Counseling Medical Clearance Form

Exercise Class Medical Clearance Form – There are numerous employee engagement programs that companies provide to their employees such as promoting a wellness activity by welcoming participants for exercise classes. However, the management should prevent employees who have severe medical conditions to be participants of the program as it may trigger their sickness in the program’s duration.

This is when an exercise class medical clearance form is used by the company’s physician for his or her fitness assessment to determine if an employee is capable of doing strength and aerobic training session feed backs or if he or she is better off meditating with a yoga instructor.

Exercise Class Medical Clearance Form

Medical Training Clearance Form – On an annual review basis, stroke is known to strike a number of over seven-hundred thousand people worldwide. This illness will limit an individual to do activities which include opening his own mouth, moving his arms, as well as walking with his legs and feet. With this, exoskeleton gait training sessions are provided as a treatment for those who have been into this illness and will want to step on his foot again.

The trainers require a completed training medical clearance form before they will proceed with the sessions. The patient’s physician must indicate data and contact information of the patient along with his medical diagnosis for the patient’s spine condition.

Medical Training Clearance Form

Medical Service Clearance Form – Aside from strokes and mental disorders, hearing impairments are also evident globally which became the reason why companies who manufacture hearing aids are growing enormously. With a hearing service medical clearance form, the deaf patient’s physician can indicate the need of the patient to acquire a hearing aid or instrument immediately. A formal letter from the manufacturing company is attached on top of the form to address the intention of the company with regards to the hearing aid request of the patient.

Medical Service Clearance Form

Medical Participation Clearance Form – During the university’s intramural and sports week, athletes from varying colleges, states, and educational institutions meet up to a particular venue and compete for different games. An intercollegiate athletics medical clearance form is required to be enclosed with the tryout application packet upon the submission and the procedure of athlete registration.

To allow an athlete in proceeding to the games, he needs to present a confirmation from the physician that he or she is medically and physically cleared to play by going through an appropriate examination provided by hired healthcare providers of the university.

Medical Clearance Participation Form

Internship Medical Clearance Form – An on the job training is a necessary phase in college education which allows a student to get out of the campus and experience the life of being in the industry. The internship medical clearance form is intended for these students which will be filled out by their physician. It states the medical status and standards of a company with regards to their interns and trainees. The student must sign the medical consent and authorization to permit the physician in releasing his medical information for the company’s requirements.

Internship Medical Clearance Form

Medical Association Clearance Form – To be a member of a dirt kart association and any extreme sports group will demand an individual to be physically active and healthy. Associations that deal with these activities require their members and clients to have a medical examination performed by a licensed and suggested physician. This is to assure that a member who will be participating in the sports does not have any disability. The medical clearance must include a medical form declaration about the condition of the association member along with the signature and stamp of the doctor.

Medical Association Clearance Form

Medical Injury Clearance Form – This is a medical form which is expected to be returned to an athlete’s coach after obtaining a clearance certificate from the physician. Specifically, this contains the information of the athlete, the details of his or her injury or illness, the type of required medical clearance and the name of the medical practitioner who performed a set of examinations to the athlete. The decision of whether the athlete will be able to join the training again or return to the competition is indicated in the last section of the form.

Medical Injury Clearance Form

Minor Medical Clearance Form – There are some educational institutions who promote the welfare of the wildlife and any animal in the world. With this, they require their participants and students to present a signed minor medical clearance form from their physicians. This is due to the need of the institution to protect and secure the health of their students. The physician should completely describe if a student has an emotional and physical issue when it comes to dealing and managing animals to avoid problems during their activities and trips to the zoo.

Minor Medical Clearance Form

Medical Patient Clearance Form – Expectant mothers and those who have been into pregnancy are the main targets of using this document whenever they will enroll in a class for their health and wellness. The participating mother should state her name on the form’s provided space at the first section, and she must submit the form to her doctor who will continue filling out the significant fields of the form.

If there are any restrictions, a doctor’s note will be found on the form which indicates the possible medicine and medical procedure that the participant must take. The doctor’s general details are also on the form which contains the doctor’s name, address and signature.

Medical Patient Clearance Form

Medical Nurse Clearance Form – Nursing and medical schools need their students to be healthy and should not have any contagious disease which may spread around the campus. However, as students are prone to living outdoors, there is a great expectation that colds and flu will be evident to any child.

This is why nursing students who return to school from their illness needs to submit a medical clearance and a medical certificate to signify that the student is no longer a harm to the campus residents. A student information section, type of clearance specification, comments area and the details of the practitioner are the main parts of this form.

Medical Nurse Clearance Form

Physician Medical Clearance Form – Fitness and health screening is important before conducting any activity. The results of an individual’s screening may be included in the submission of a medical clearance form to prove one’s health status. The form is also enclosed with the individual’s detailed health and physical history, as well as his or her immunization records. The last part of this form contains the physician’s statement of fitness which is vital for determining the capability of the patient or the individual whom the clearance will be addressed.

Physician Medical Clearance Form

Physiotherapy Medical Clearance Form – This is a simple document which mainly states the name of the participant, the date when the physician’s approval was granted and the physician’s signature with his name. Though it promotes a simple outline, the importance of having this form is to guarantee that the pool exercise participant will not be at harm as he or she joins in the group.

Other documents which may be required to accompany this form includes the participant’s medical forms, a parental consent for minor participants and a waiver of liability agreement which secures that the responsibility in events of an injury will not be pointed to the kinesiologist and the pool organization.

Physiotherapy Medical Clearance Form

Retreat Medical Clearance Form – Almost half of the world’s population want to lose weight to obtain their dream body size and to fit into most dresses with universal measurements. However, losing weight is dangerous for one’s physique as it may affect the mental state of an individual and increase his or her health risks if done wrong.

This harm and danger open up the need for weight retreat organizations to use a medical clearance form before they accept a new client. The form acts as a medical verification which is supplied with a client’s verified information from a licensed physician with regards to the client’s health claims.

Retreat Medical Clearance Form

Basic Medical Clearance Form – Based on statistical studies, a patient dies every single hour due to a type of skin cancer which is commonly known as melanoma. This is the reason why surgical companies and doctors take a great precaution whenever they deal with patients who want to do facial and skin therapy sessions.

However, with a skin medical clearance form, the doctor or surgeon will be able to conduct a quick client assessment and know if he or she would proceed with the skin therapy or decline the client’s request. If the client is clear from any triggers of skin cancer, then his or her physician must authorize and state that he or she is granting the client an approval for the therapy.

Basic Medical Clearance Form

Medical Clearance Form for Stress – Before an organization permits an individual to perform in a stress and fitness test, they require the individual to fill out this form with a licensed physician. The physician’s name, the field of industry and contact details are to be stated on the form for the purpose of verifying the physician’s legalities and license. Additionally, it must have the date when the evaluation was granted to make sure that the medical examination was done in the current year or that the results were up to date.

Medical Clearance Form for Stress

Student Concussion Medical Clearance Form – Concussions are caused by an impact or a force which may relate to sports and other activities demanding a participant to be physically vigilant in the field. The physician who examined the student is required to state whether the student has been cleared out from the concussion, and be able to participate in his or her academic subjects, or if the student is recommended to remain at home to heal with the medication. The form also has the parent’s contact information and details for the school to have a record of who they may contact in case of an emergency.

Student Concussion Medical Clearance

Student Recreation Medical Clearance Form – This form is a document given to the student if he or she answered “yes” to a particular question that indicates an illness or disability on the health history form provided by the school’s recreation team. The approval or disapproval of the physician is required on the form to properly determine if a student has been true with his or her answers on the previous questionnaire, and if there is a need for special assistance if the student is approved for joining the recreation activity.

Student Recreation Medical Clearance

Touch Football Medical Clearance Form – Even though a football player is deemed as an individual who has an illness, the physician may give a touch football medical clearance upon clearing out to the player that the health or medical responsibilities will be upon his or her actions.

As the football organization may need the disclosure of the player’s medical information, the player is requested to sign an enclosed patient consent form to allow the organization in searching through his or her medical files or data. Nevertheless, if the player demands protection and confidentiality for his or her data, he or she can acquire a negotiation with the organization to limit their access and rights.

Football Medical Clearance Form

Medical Tour Clearance Form – Going out to hike and take an island tour is a known activity that builds the relationship of nature and men. However, regardless of how tempting it is to immediately climb the steep slopes of a mountain, an individual and his  or her associated organization should be responsible for assuring that all the involved parties are capable of the activity.

This is when a tour medical clearance form will be filled out by the participant’s physician and cardiologists to state the medical and heart condition of the participant. A section of the form focuses on the details of the participant’s health to determine his or her level of eligibility for participating.

Medical Tour Clearance Form

Medical Training Clearance Form – The term training does not only limit to physical activities of athletes and sports enthusiasts but also to activities which demand the participant’s mind to work such as scholastic courses and workshops. For this intention, a training medical clearance form may be needed for the participants especially if they will be staying in the workshop’s premises for the duration of the training.

This form is submitted during the training or workshop registration process as it aids the organization in deciding of whether they will accept the participant’s registration, or they will decline with a legal and valid reason.

Medical Training Clearance Form

Yoga Medical Clearance Form – Yoga involves stretching, bending, twisting, and breathing exercises. For the yoga beginners and participants, it is essential that they are aware of their medical condition to avoid further complications of their state. With this, a yoga medical clearance is often required by yoga instructors along with a signed yoga waiver. The intention of having the clearance is to inform the instructors about the yoga participant’s restrictive body movements due to a disability or illness. Though this is only a single-page document, it plays a vital role in maintaining the health and laying down the assistance needed by each participant.

Yoga Medical Clearance Form

What’s Included in a Medical Clearance Form?

Though a medical clearance form is a single document to be used by a licensed and authorized physician, there are other papers which should be included, enclosed and attached with the form. Listed below are the following significant and legal forms:

Medical Records Release Authorization

It is vital to have this release authorization to secure that the requesting organization or agency has been granted with the full permission of the patient regarding the collection of medical information about him or her. The release also protects the patient from dealing with future privacy and confidentiality issues with the usage of his or her details.

Medical History

The purpose of having this inclusion is to let the physician and the organization know the medical form indicating the background of the patient; determining if he or she has been diagnosed with a specific illness before or if his  or her medical state has been healthy and improved after a medication.

Physical Examination Results

As the aforementioned medical history aids the physician in learning about the previous state of the patient, the physical examination results will distinguish the patient’s current state. This should be in full descriptions to inform all the parties involved about limitations and physical boundaries of the patient.

Medical Action Plan

Other medical clearance form names this significant inclusion as the physician’s recommendations and suggestions. This refers to the medication, treatment, and the possible action plan that both the organization and the patient are expected to follow such as engaging the patient in a counseling session or taking a particular medicine.

Return to Play Medical Clearance Form

Medical Clearance Report Form

Basic Medical Clearance Form

Why Is a Medical Clearance Voided?

Similar to other clearance forms, a medical clearance can also be deemed as a voided property or document by any organization. One known reason why a clearance is voided can be due to an injury or accident wherein the clearance-holder was involved a few days or months before he or she uses the clearance. Voiding due to this reason is important to acquire a thorough and updated medical status of the clearance-holder. The new clearance for employee will then determine if the holder is in good shape, and consider for continuing his or her participation with the organization.