The first 10 years of an academically affiliated occupational and environmental medicine clinic were described. The clinic was founded in July 1981 as part of the Occupational and Environmental Program of the University of Washington, Seattle. Altogether, 6048 patients were evaluated at the clinic between July 1981 and July 1991. Of these, 2841 were evaluated in the diagnostic clinics and 3207 in one of the 18 screening programs developed for a variety of occupational groups including firefighters, hazardous waste workers, and workers exposed to asbestos (1332214). Of the persons seen in the diagnostic clinics, 76% were working age males; 77% were white and 12% were African American. Physicians and self referrals accounted for 51% of the referrals. Approximately 55% of the patients were diagnosed as having a work related condition. Asbestosis, asbestos related pleural diseases, other respiratory conditions, acute or chronic encephalopathy, musculoskeletal disorders, hearing loss, asthma, carpal tunnel syndrome, and dermatitis were the most frequently diagnosed conditions. Asbestos was identified as the major potentially hazardous exposure, followed by organic solvents, welding fumes, vibration, other chemicals, metals, pesticides, and repetitive motion. The most frequent occupations of the patients were plumbers, welders, hazardous waste workers, painters, sheet metal workers, and furnace installers. Shipbuilding and construction were the most frequent industries in which the patients were employed. The program also provided consultative services to community physicians and training specialists in occupational medicine.