DOT Patient Information
$100.00 non-refundable deposit for appointment.
Base charge is
$250.00. A urine analysis is require by law, and this is an additional $25.00 The deposit will be applied toward the first visit. Additional
procedures and record review will be extra depending upon time and complexity. A minor review of records
will not be extra. These are very exacting histories and physicals in full compliance with the strict new guidelines of the
Federal government’s Department of Transportation (DOT). If you are looking for a fast rubber stamp
job do not come. You will benefit from this in your personal health care by having had a true physical.
hour early if you have not filled out the patient history questioner on the DOT form. You can print this
from my website (drzend.com), or we can fax it to you. If you print it from my website only print pages
1& 2. You can also come by and pick up a copy. Arrive 15 minutes early if you have filled this
out. Download the patient information and consent to share information form for your employer. This is under
the New Patient section of the navigation bar. Wear clothing that is loose and easily removed. Females
will not be given female examinations.
If you have a prior history that may effect your certification have the information sent
prior to the exam. This will expedite your certification. A copy of a release of medical
information form can be copied from my website.
Eye glasses, contacts or hearing aids: Be sure to bring them to the
Medication: Be sure to be on all of your medication (especially blood pressure meds) for two weeks prior to the
exam. If you fail a part of the exam because you have not been taking your meds this will cause a delay,
or even disqualification, for your certification.
Diabetics: I will need at least two of your last A1C’s.
A blood sugar diary will help you pass more easily.
Heart Conditions: If you have suffered a heart attack, have a valve
problem, have heart failure you will need to send the latest cardiologist report. If you have had a stress
test, nuclear profusion or an echocardiogram have the results of this sent prior to the exam.
Pulmonary (Lung) Conditions:
Have your most recent Pulmonary Function Tests sent to us.
Sleep Apnea: We will need a document showing that the CPAP is being used with benefit. This can either be a
printout from your CPAP or an updated sleep study on the CPAP.
Anticoagulants: Have your last three Protimes (INR’s) sent ahead of you.
Drug and Alcohol
Problems: If you have been through a Substance Abuse Professional’s program bring a copy that shows
your completion. You may be required to have a urine drug screen through your employer.