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(952) 920-5663
OMC Client Registration
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Administrative Contact for Questions and Additional Information may be reached at: (612) 327-4926
Company Information
Company Name
Company Website
Company Address 1
Company Address 2
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Description of your Business
Company Contact Information
Primary Contact Name
Primary Contact Title
Primrary Contact Phone
Primary Contact Email
Company Fax
Company Billing Information (if different from above)
Billing Contact Name
Billing Contact Phone
Billing Contact Address 1
Billing Contact Address 2
Billing City
Billing Zip
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Billing Email
Billing Fax
Work Comp Insurance Carrier
Specimen Collection Only
Collection, Lab, MRO Package
Medical Review Only
Random program
To Establish details please have MRO Office contact:
Pre-Placement: all occupations (including firefighters, law enforcement, military)
Government service exams: DOT; FAA; FRA; FTA; Nuclear; Pipeline; Coast Guard
OSHA Surveillance program management and/or testing
Audiometric Testing/Hearing Conservation CAHOC certified technicans
Respirator Wearer: questionnaire review; spirometry; fit testing: Certified technicians
Fitness For DutyRespirator Wearer: questionnaire review; spirometry; fit testing: Certified technicians
Return For Duty Exam
Return For Duty Exam
Haz Mat / Exposure / Environmental
Ergonomic Consultation / work site evaluation
International Travel Consultations / Immunizations provider
Health and Wellness Consultations
Audiometic Testing
Blood borne pathogen training / Hepatitis A & B vaccination
Health Fair Events
Health & Wellness Training Programs/presentations
MD DOT Exams
MD Worksite Evaluation: Ergonomic Consultation
Respirator Wearer / pft/spirometry / Fit Testing
Tuberculosis Screening (Mantoux)
Pre-Placement Health Screening
Respirator Questionnaire Review
I have questions, please contact:
