Columbia Park Medical Group

Appointments - Occupational Medicine

If you are requesting an appointment for a New work injury, please call us at (763) 572-5717. Do not send request via the Internet. Thank you.
Company Information
Company Name : Company Phone:	Co. Address 1: Co. Address 2:	Contact Person: Email Address:
Appointment Information
Type of appointment request:
Physical: Type of physical:	Lab: Type of Lab:	Injury Recheck: Type of Injury:
Employee Information
Employee Name: Employee Social Security Number:		Date of birth:

Are you requesting more than one employee physical?

If more than one physical is being requested, please enter Name, Social Security Number and Type of Physical for each employee:

History | Services | Physicians || Pharmacy | Business Services
Employment | Physician Recruitment | Online Appointments | Patient Forms
Andover | Blaine | Brooklyn Park | Columbia Heights | Fridley | Imaging Center

FOR APPOINTMENT CALL 763-572-5700