Follow the steps to complete the form accurately.

1. Press the ‘Get Form’ button to access the Health Statement Physical Record and open it in your document editor.
2. In Part 1, begin by filling in the name of your physician in the designated space. This information is crucial for identifying the medical professional responsible for your evaluation.
3. Write the date of completion in the provided space. Make sure to use the current date to ensure the record is timely.
4. Next, enter your full name in the line that reads 'I, _________________________________________________'. This section gives you the authority to allow your physician to share your medical information.
5. Fill in your employment role in the section that says 'as a _____________________.'. This detail helps contextualize your medical evaluation.
6. Sign the document in the space marked 'Signature of Patient / Social Security #'. This signature is your authorization for the physician to release the information.
7. Provide your phone number following your signature for any necessary follow-up or clarification.
8. Part 2 is for the physician to complete. Ensure your physician examines and provides the required assessment of your medical qualifications.
9. The physician should complete the statement regarding your physical and medical qualifications, noting any relevant comments in the provided area.
10. Finally, the physician should fill out their office address and telephone number, followed by signing and dating the form.
11. Once completed, you can save your changes, download the finalized document, print it for your records, or share it as needed.

Take action now and complete the Health Statement Physical Record online to streamline your employment process.