Caduceus Patient Check-In

Welcome to Caduceus

ClinicCaduceus USA

Please complete your information below to check in. It takes about two minutes and saves time at the front desk.

Reason for Visit

Choose the one that best matches your visit. *

Physical Drug Screen Work Injury – Initial Visit/Eval Work Injury – Follow-Up Testing

Please choose a reason for your visit.

Patient Information

Enter your details exactly as they appear on your ID.

First Name *

Required.

Last Name *

Required.

Suffix (optional)

Gender *

Required.

Date of Birth *

You can type the date (MM/DD/YYYY). Patients must be 18 or older.

Required.

Social Security Number *

Please enter a valid 9-digit SSN.

Encrypted & transmitted securely

DL State *

Required.

Driver's License # *

Driver's license must be 6–13 characters.

Job Title (optional)

Employee ID (optional)

Address

Your current home address.

Address Line 1 *

Required.

Address Line 2 (optional)

City *

Required.

State *

Req.

Zip *

Req.

Contact

So we can reach you about results or follow-up.

Email *

Please enter a valid email address.

Contact Number *

Please enter a valid 10-digit phone number.

Request Comments (optional)

Medical

Please list any allergies and current medications. Enter "None" if none.

Allergies *

Required. Enter "None" if you have no allergies.

Current Medications *

Required. Enter "None" if you take no medications.

Employer Information

Optional — if you were sent here by an employer, please fill in what you know.

Company Name (optional)

Department / Job Site (optional)

Supervisor / Contact (optional)

Supervisor Phone (optional)

Injury Details

Please tell us about the injury.

Date of Injury *

Required.

Claim Number (if known)

Body Part(s) Injured *

Required.

How were you injured? *

Required.

Photo ID / Driver's License

Optional — take a quick photo of your driver's license or ID card to speed up check-in.

Authorization & Consent

The information provided is correct to the best of my knowledge. I authorize Caduceus to provide any required medical services for me, and to release the medical information to all parties related to my care.

Signature *

Sign with your finger or stylus

Please sign to continue.

Your information is protected under HIPAA and transmitted securely
to Caduceus Occupational Medicine. Questions? Ask the front desk.

You're checked in

Thanks! Your information has been sent to the front desk. Please have a seat — we'll call you shortly.