Providing Quality Health Care and Continuous Communication for Employees and Employers
Kettering Workers' Care
Forms
Click on the thumbnails below to familiarize yourself with our forms.
Kettering Workers' Care South
333 Conover Drive
Franklin, OH 45005
Phone: (937) 746-8795
Fax: (937) 746-7062
Kettering Workers' Care Central
2023 Springboro West
Dayton, OH 45439
Phone: (937) 293-7770
Fax: (937) 293-9982
Kettering Workers' Care North
8701 Old Troy Pike
Huber Heights, OH 45424
Phone: (937) 237-6231
Fax: (937) 237-6221
Clinic Information Sheet
DOT / FAA Drug Screen Only
DOT / FAA Drug Screen Only
Patient Hearing History Questionnaire
Clinic Information Sheet
DOT / FAA Drug Screen Only
DOT / FAA Drug Screen Only
Hair Collection Testing
Kettering Workers' Care
Medical History and
Physical Record
Medical History and
Physical Record
Kettering Workers' Care
Testing Consent Form
Testing Consent Form
Clinic Information Sheet
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