Medical Clearance Form: PDF Examples

LJ Acallar

September 11, 2025•15 min read

Fact checked by Dr. Ben Condon

Template

Medical Clearance Form

This medical clearance form allows clinicians to permit physically and mentally healthy individuals to undergo certain procedures or activities. It includes details capturing relevant information such as health summary, restrictions or special needs, and the doctor’s certification.

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What is a Medical Clearance Form?

A medical clearance form is an official permission slip assessing a person’s suitability for activities or procedures that may involve risk or induce stress.

Medical clearance forms gather essential health information of a patient before undergoing a specific activity. Healthcare professionals are typically in charge of reviewing the form, regardless of whether they will approve or refer it to a specialist or an institution. Medical clearance forms are used most commonly in settings such as:

Surgery: Surgeons typically need a surgical clearance form from a general practitioner to confirm if a person is fit for anesthesia
Employment: Patients returning from illness or injury need to be cleared for physical fitness before coming in to work
Sports: Athletes need a medical clearance form to proceed with playing without significant physiological risks
Travel: Some entities might require passengers to gain medical clearance for flights or fitness-to-fly forms under certain conditions: a traveler has a contagious disease, they require medical care in-flight, or they are dependent on specialized medical equipment

In this article, we’ll explore the importance of medical clearance forms and how compliant, AI-powered solutions streamline documentation for clinicians.

The Importance of Medical Clearance Form Templates

In the ever-evolving landscape of technology in healthcare, it is more important than ever to ensure compliance, to standardize quality across automated processes. Medical clearance form templates are one way to ensure legal and organizational requirements consistently align with health regulations.

Medical clearance form templates are powered by AI, a modern solution that has become a necessity in response to the increasing complexity of documentation. This automated solution limits the time for clinicians to document the physical and mental fitness of a person, so they have more leeway in their typical day.

Types of General Medical Clearance Forms

General medical clearance forms support safety assessments and operational planning. They include, but are not limited to, the following: travel, sports, and employment. Below are more examples and types of general medical clearance forms.

Medical Clearance Forms for Travel

Travel medical clearance forms typically require Medical Information Forms (MEDIF) to ensure the health and safety of all individuals. While the forms are particularly for those needing critical care, they also prevent the spread of health risks among travelers.

The examples below show examples of how passengers can cross borders without posing a health risk to themselves or others:

American Airlines Medical Clearance Form - American Airlines often requires a physician’s consent form for travelers who fly with a Portable Oxygen Concentrator (POC). It highlights the responsibility of the flying passenger or caregiver to operate the FAA-approved device securely.
United Airlines Medical Clearance Form - United Airlines mandates medical certificates for passengers who present higher health risks, like communicable diseases. This appeals to travelers who can confirm that they can finish the flight without the need for urgent care.
British Airways Medical Clearance Form - British Airways needs to know the exact medical condition a passenger has and what type of support they’ll be needing for flights. This medical form is their way to assess whether travelers requiring POC are medically fit to fly.

Medical Clearance Forms for Sports

Sports-related medical clearance forms serve as a medical safety checkpoint and a legal safeguard for athletes. In cases where a player, regardless of age, needs clearance to enter or return to a sports team, these forms must be evaluated by a treating physician first.

Below is a list of examples:

American Youth Football Medical Clearance Form - This form evaluates a young athlete's readiness to play by documenting their medical history, injury risks, and the physician's recommendations. It acts as a doctor's certification, providing a safety net and ensuring accountability, as the child cannot return to play without a physician's re-clearance.
Australian Football League Medical Clearance Form - This form creates an official record to protect the young player returning from a concussion. It allows legal guardians to sign on behalf of the player and serves as an extra precaution in case symptoms recur.

Medical Clearance Forms for Employment

Medical clearance forms for job-related purposes generally evaluate the suitability of people for vacancies that require approval from certain employers. There are also forms that assess the ability of an individual to safely use protective work equipment.

Below is a list of examples for medical clearance employment forms:

DMV Medical Clearance Form - In the US, government agencies such as the Department of Motor Vehicles (DMV) utilize a medical clearance form to verify that individuals in roles requiring safe vehicle operation meet the necessary health standards. This ensures the driver is fully capable of performing their duties safely.
DOT Medical Clearance Form - This form is also known as a Department of Transportation (DOT) physical in the US. It is designed for commercial drivers to assess their suitability for roles requiring DOT approval, as they need to obtain or maintain a Commercial Driver’s License (CDL).
OSHA Respirator Medical Clearance Form - This form serves as a provider's evaluation of an individual's ability and fitness to safely use respiratory equipment. It helps prevent potential risks by identifying medical conditions that could be exacerbated by respirator use. This form is a requirement under the OSHA Respiratory Protection Standard.

Filling out medical clearance forms is simplified with existing filler tools. Heidi, designed by clinicians for clinicians, automates this manual task and integrates seamlessly into your workflow from the moment the patient arrives. This is why Dr. Katherine Skellern, Developmental Paediatrician, shares her challenges in documenting the progress of children with diverse needs:

"There was a child with autism who needed a personalised letter for their teacher, while another needed a comprehensive diagnostic report for the NDIS and for the parents as an assessment summary. The mental juggling act of switching between different types of documentation was exhausting, and I often found myself getting stuck in the details, which took away from the time I could spend with my patients,” she recalls

Ensuring compliance with standard regulatory requirements so she doesn’t have to worry, Heidi’s AI medical scribe saved Dr. Skellern a significant amount of time, handling every part of documentation efficiently. "I had a child with ADHD, and instead of scrambling to write a referral letter for a psychologist, I just hit ‘create letter,’ and Heidi automatically generated a letter based on what we had discussed in the consultation that was perfectly suited to the child’s needs. I was able to hand it to the parent on the spot. The parent was amazed and so grateful that this was done so quickly."

How to Write a Medical Clearance Letter

Generally, writing a medical clearance letter starts with the purpose and the health status of the individual. Next is the inclusion of personal information and HPI alongside physical exam results, and details on treatments and restrictions. Finally, the physician’s signature and contact details should be mentioned in the letter following the clearance statement.

Medical clearance forms typically cover general health; however, dental and surgical clearances are often separate. This distinction is due to specific risk assessments required for these procedures that a general clearance does not cover. Here are more specific examples detailing various types of medical clearances.

Medical Clearance Form for Dental Treatment

Dental treatment medical clearance forms are a safeguard for dentists to confirm that patients can undergo dental procedures safely. They are often distinct from general medical clearance forms, with details such as a list of planned dental tasks, medical history flags, and other specialized requests. Since patients carry unique or legal risks that come with tooth extractions or oral surgery, this form serves as the official sign-off.

Medical Clearance Form for Surgery

The surgical medical clearance or pre-operative clearance is also different, as surgeons may provide an operation or anesthesia to patients. This form generally notes descriptive clinical data and clinical exam findings to be able to identify additional diagnostics required. What makes this form distinct from others is its binding nature of approval once the physician has given a clear, definitive decision and a signature.

Medical Clearance Form Sample PDF

Sample PDF automatically filled by Heidi for demonstration purposes only. No PHI or PII was used. Content is from a simulated session and not based on real individuals.

If you ever wished that documentation is a task you could easily tick off at the end of the day, Heidi is precisely built to be that: your AI care partner. Heidi simplifies the process of drafting medical clearance letters and completing health clearance forms for various needs. Adopted by clinicians who join our template community, Heidi helps you reduce the weight of cognitive stress from admin.

Auto-Complete Medical Clearance Forms with Heidi

Filling out medical clearance forms is easy, but with Heidi automating your documents, you can fill out more forms or save time to allow for more vital tasks. Heidi’s form-filling features don’t omit your authority on the documents; it only handles the manual aspect, so you can focus on better care. Heidi ensures your medical clearance forms do not violate patient data regulations.

Heidi fills out your forms so you can enjoy other benefits:

Get 30+ departments on the same page: Heidi caters to up to 200 specialties, which doesn’t hinder its capability to tailor to your documentation needs.
Win patients for life: You can maintain eye contact, and patients feel heard because Heidi understands medical context and language.
Generate documents with a click: A single comprehensive note automates the follow-up process, so instead of excessive paperwork, you’re left with simple task designation and multiple document generation in one sitting.

Heidi facilitates more than 2 million patient consultations weekly, ensuring region-ready compliance and enterprise-grade data localization in Australia, Canada, the US, the UK, and other countries.

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Frequently Asked Questions about Medical Clearance Forms

What does a medical clearance consist of?

A medical clearance consists of a physician’s go signal indicating that individuals are healthy enough with minimized risk before a certain activity or procedure. This evaluation form contains basic patient information and history, results of medical exams, and notes from past sessions. The goal of this document is to 1) identify potential medical risks, 2) log medical history as a future supporting document, and 3) ensure the patient is physiologically prepared.

Can I get a medical clearance letter online?

Yes. Telehealth services make this possible as they bridge the connection between you and patients. You can obtain a medical clearance letter online in PDF, and Heidi can auto-fill the fields to streamline your workflow. Simply upload your formatted medical clearance PDF form (Heidi automatically detects the fields needing filling) and select your newly uploaded PDF template. Heidi will automatically complete all PDF fields based on session details, and with auto-download enabled, you don’t even need to click anything!

How long does medical clearance take?

A medical clearance can be obtained on the same day of the visit, or it may take up to several weeks. There is no definitive time, as it depends on the severity of the medical condition and the complexity of other factors. For example, the turnaround time for clinicians to sign off simple clearances can be same-day to 48 hours. On the other hand, clinicians might need a longer time frame minimum of 21 days, for sports, dental, or surgical recovery-related clearances.

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