Employer Request & Authorization
Please ensure your employee brings a valid photo ID
  • General Information

  • / /
  • Drug and Alcohol Testing

  • Covid Services

  • Vaccinations

  • Physical Exam

  • Please Upload applicable Job Description
  • Workers Compensation

  • Other Services

  • File Upload

    Upload any additional Protocols or Authorization forms as needed
  • Billing

  • Claim Number
  • Employer Name
  • Authorization