Skip to main content
Explore links (header)
  • UCLA Health Home
  • About Us
  • Cancer Center
  • Hospitals & Clinics
  • School of Medicine
  • Academic Departments
  • News & Insights
  • Community & Equity
Universal links (header)
myUCLAhealth
Contact Us
  • English
  • العربية
  • 中文
  • Italiano
  • 日本語
  • 한국어
  • فارسی
  • Русский
  • Español
  • Tiếng Việt
  • English
  • العربية
  • 中文
  • Italiano
  • 日本語
  • 한국어
  • فارسی
  • Русский
  • Español
  • Tiếng Việt
Search
Try looking up a doctor, a clinic location, or information about a condition/treatment.
Examples
  • "Lin Chang" for a Doctor by name
  • "Flu Symptoms" for a Condition
  • "Cardiologist" for a Doctor by specialty
  • "Santa Monica" for a Location
UCLA Health
Primary navigation
Find Care
  • Find a Doctor
  • Find a Location
  • Virtual Care
  • Make an Appointment
  • Second Opinion Consults
  • Medical Services
  • Cancer Medical Services
  • Clinical Trials
  • Wellness & Routine Care
Patient Resources
  • Prepare for Your Visit
  • Billing & Insurance
  • Support & Information
  • Patient Portal (myUCLAhealth) & Medical Records
  • Help Paying Your Bill
  • International Services
  • Patient Scam Alert
Locations
  • Immediate Care
  • Primary Care
  • Pediatric Care
  • Cancer Care
  • Surgical Centers
  • Imaging/Radiology
  • Hospitals
  • All Locations
Discover
  • About UCLA Health
  • News & Insights
  • Patient Stories
  • Events Calendar
  • Donate to UCLA Health
  • Work at UCLA Health
  • For Health Care Professionals
  • Connect with UCLA Health
  • Care Compliments
Find a Doctor
Primary navigation (mobile)
Find a Doctor
Find Care
  • Find a Doctor
  • Find a Location
  • Virtual Care
  • Make an Appointment
  • Second Opinion Consults
  • Medical Services
  • Cancer Medical Services
  • Clinical Trials
  • Wellness & Routine Care
Patient Resources
  • Prepare for Your Visit
  • Billing & Insurance
  • Support & Information
  • Patient Portal (myUCLAhealth) & Medical Records
  • Help Paying Your Bill
  • International Services
  • Patient Scam Alert
Locations
  • Immediate Care
  • Primary Care
  • Pediatric Care
  • Cancer Care
  • Surgical Centers
  • Imaging/Radiology
  • Hospitals
  • All Locations
Discover
  • About UCLA Health
  • News & Insights
  • Patient Stories
  • Events Calendar
  • Donate to UCLA Health
  • Work at UCLA Health
  • For Health Care Professionals
  • Connect with UCLA Health
  • Care Compliments
Explore links (mobile)
  • UCLA Health Home
  • About Us
  • Cancer Center
  • Hospitals & Clinics
  • School of Medicine
  • Academic Departments
  • News & Insights
  • Community & Equity
Universal links (mobile)
myUCLAhealth
Contact Us
Breadcrumb
  1. Home
  2. Departments
  3. Occupational Health
Occupational Health

Forms

Sub-navigation

Occupational Health

  • Pre-Employment
  • TB Screening
  • Employee Injury and Illness Care
    • Bloodbourne Pathogen Exposure
    • Infectious Diseases Post Exposure
    • Respiratory Illnesses
    • Workstrong Program
  • About Us
    • Leadership
    • Location & Hours
    • Services Provided
    • Medical Records
    • Contact Us
  • Forms
  • Pre-Employment
  • TB Screening
  • Employee Injury and Illness Care
    • Bloodbourne Pathogen Exposure
    • Infectious Diseases Post Exposure
    • Respiratory Illnesses
    • Workstrong Program
  • About Us
    • Leadership
    • Location & Hours
    • Services Provided
    • Medical Records
    • Contact Us
  • Forms

If you are visiting Occupational Health for the first time, you will complete your forms in our office on an iPad or you can sign up for MyChart to begin your registration. 

myChart icon

Declination Forms

  • Tdap Declination Form
  • Hepatitis B Declination Form
  • Rabies Declination Form

Worker's Compensation, Employer's First Report of Injury or Illness

  • Incident Reporting and Referral for Medical Treatment Forms
  • Generic HIPAA Med Release
  • How to Fill Prescriptions Form
  • Concentra Employer Authorization Form
  • Student Worker Employment Verification

Tuberculosis

  • TB Requisition Form
UCLA Health
  • Facebook
  • X-Twitter
  • Instagram
  • YouTube
  • LinkedIn
  • Weibo

Policy links (footer)

  • HIPAA Notice
  • Privacy Notice
  • Nondiscrimination
  • Report Misconduct
  • We listen. We care.
© 2026 UCLA Health