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

EMPLOYER AUTHORIZATION FORM (PDF)

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

Physical Form (PDF)