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Authorization Services

Injury Care Associates makes receiving services easy. We accept walk-in as well as scheduled appointments. 

Please complete the below Employer Authorization to specify the services you would like Injury Care Associates to perform. 

Injury Care Associates accepts Authorizations via the electronic submission below, telephone or you can download a copy of our Employer Authorization Form and fax it to the clinic or have your employee bring it with them to the clinic. If your employee arrives at the clinic without an Employer Authorization, we will contact you to verify the services you need performed to ensure complete and accurate service delivery.

PDF Form
Employee Information

Employee Information


Work Related Injury, Illness or Exposure


Drug & Alcohol Testing


Physical Examination
Physical Examination

OSHA Exam

OSHA Examination


Immunizations

Blood testing

Blood Titer Testing


Additional Services

Please any and all additional sevices you would like Injury Care Associates

Other

Authorizer's Information

Please provide the information requested below in case Injury Care Associates needs to contact you with any questions.


Please note that only patient and staff are allowed in the drug/alcohol testing and clinical areas and that employer, family and friends will be asked to remain in the waiting area. Please notify your employee so they may plan accordingly