Forms

Forms for Authorization for Corporate Care Services

Employers and employees must complete the following forms for authorization for Corporate Care services.

In addition to forms below, please be certain to bring photo proof of identification, such as a driver's license or work ID card. Minor employees who need treatment must be accompanied by a parent or legal guardian, or must have a notarized statement from the guardian or parent authorizing the employer to give permission for treatment as needed.

For New Injury or First-Time Visits

We must have authorization from your company/employer to administer treatment without delay.

Employers should provide injured/sick employees with a completed and signed Employer Authorization Form for presentation at the first visit.

Post-offer Pre-employment Physical Form

RWJBarnabas Health Corporate Care - Lakewood
1195 Route 70, Suite 1000
Lakewood, NJ 08701
(732) 942-5851
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Cooperman Barnabas Medical Center
94 Old Short Hills Road
Livingston, NJ 07039
(973) 322-5000
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Monmouth Medical Center
300 Second Avenue
Long Branch, NJ 07740
(732) 222-5200
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Clara Maass Medical Center
1 Clara Maass Drive
Belleville, NJ 07109
(973) 450-2000
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Community Medical Center
99 Highway 37 West
Toms River, NJ 08755
(732) 557-8000
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Jersey City Medical Center
355 Grand Street
Jersey City, NJ 07302
(201) 915-2000
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RWJ University Hospital Somerset
110 Rehill Avenue
Somerville, NJ 08876
(908) 685-2200
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Trinitas Regional Medical Center – Williamson Street Campus
225 Williamson St
Elizabeth, NJ 07202
(908) 994-5000
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Medemerge
1005 North Washington Avenue
Green Brook, NJ 08812
(732) 968-8900
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RWJ University Hospital Hamilton
1 Hamilton Health Place
Hamilton, NJ 08690
(609) 586-7900
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Robert Wood Johnson University Hospital
1 Robert Wood Johnson Place
New Brunswick, NJ 08901
(732) 828-3000
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Monmouth Medical Center Southern Campus
600 River Avenue
Lakewood, NJ 08701
(732) 363-1900
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RWJBarnabas Health Corporate Care - Jersey City
414 Grand Street
Suite 17
Jersey City, NJ 07302
(201) 885-4750
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Employee and Occupational Health Treatment & Care

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