top of page

Employee Medical-Physical Statement

  • This service qualifies for your initial employee medical-physical statement/health evaluation for Colorado Child Care Licensing. 

  • If you are purchasing the service for multiple employees, stop here. You must make a bulk purchase. You will be sent a promo code to give to your employees so they can book their own appointment and fill out their own medical history form.

  • Please note that this appointment is scheduled as a precautionary measure. We will only contact you by phone if you indicate a medical condition on your medical history form that may affect your ability to safely perform your job.

  • If you do not have any medical conditions that impact your job safety, you will not receive a phone call. Instead, you will automatically receive your medical statement by email within 24 hours of your precautionary appointment

Medical History Form

Do you have any medical or psychological conditions that could interfere with your ability to safely work with children?
Yes
No
Do you have any of the following medical conditions? Check all that apply.
Currently, are you following medically advised or prescribed work restrictions?
Yes
No
Currently, is your employer making modifications to your job duties to meet your medical needs?
Yes
No
To the best of your knowledge, did you receive all of your childhood immunizations?
Yes
No
Other
Do you agree to immediately contact your doctor for any new changes to your physical or mental health that could interfere with you safely working with children?
Yes
No
I agree to the release of liability listed on coloradocprpros.com website.
Yes
No
bottom of page