forms

requirements

Bentleyville Chiropractic offers our office forms online so they can be completed in the convenience of your own home before you even arrive to our office.


Instructions

DOT Exam Forms

Please use the above link to print out the necessary exam forms. Please fill out pages 1 and 2 as per the instructions on pages 6-9. Please fill out the top portion of pages 3-5 and bring them along with you.
*Drivers License must be present at the time of the exam.

*Please be prepared: Have your Medical History, Medications, Exemptions, Diabetes Logs, C-Pap Logs, Family Dr's name, Stress test results, Pulmonary function Tests etc. available at the time of appointment. If you do not have your information available to us, we will not be able to examine you that day.

*The upfront fee for us to perform this DOT exam is $80 whether it is a pass or a fail.

*Please be prepared to provide a urine sample by drinking plenty of water ahead of time. Avoid caffeine and nicotine prior to the test. If you smell of alcohol, we will reschedule the exam.
See you at your appointment!


See you at your appointment!

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