Pre-Medical Monitoring Referral Form

Medical monitoring is voluntary and will be provided through Duke City Occupational Health. This will provide baseline testing that is a reference point for any future evaluations. This will be offered now and again in three (3) years. If you are interested in participating in the City’s medical monitoring program, please complete the following form and submit to the Risk Management Division of the City of Albuquerque.

Fields with a red dot ^⏺ are mandatory.

Please confirm all required fields are populated before submitting your form. Fields with a red dot ^⏺ are mandatory.

Your form is not submitted until you click the Submit button and see the confirmation page which includes a recap of your completed form fields.