DOT Physical Registration Form Disabled

This is a registration form for our medical practice, we need this form up and running asap, as these types of appointments require documentation and prepaid deposits.  It will not be on any website, but completed by our staff each time they schedule an appointment for a DOT Physical.  We elected to encrypt these submissions for extra security.  Please enable this form.  

Thank you

Jennifer Mummert

Office Manager/Medical Assitant

Dr Gonsalves' Office

We apologize for this inconvenience, Jennifer.

I checked your account and found that it was automatically suspended. This happens when our filters scans and flags a form suspected of being suspicious for spam, phishing, or any malicious activity.

However, after making a review of your form, I did not find anything unusual which it can be suspected for any threat so I went ahead and reactivated your account right away. You should be able to access your forms now.

If you have questions, please let us know.

Thanks for your understanding.