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Frequently Used Forms

To further expedite the process of receiving services at Injury Care Associates, we have our most-commonly used forms available for download. Please bring a completed copy of the paperwork relevant to your services to your appointment. If bringing completed paperwork with you to your appointment, please print the paperwork one (1) sided. 

Remember, appointments are not required at Injury Care Associates and completing paperwork in advance of your visit is not required. 

Note that for all Federal (DOT) physical examination and drug and alcohol testing services, a valid Driver's License is required in order to complete these services.

  1. Authorization for Services Form (PDF)
  2. New Injury Patient Paperwork (PDF)
  3. New Injury Patient Paperwork - Spanish (PDF)
  4. Non-Injury Patient Paperwork (PDF)
  5. Non-Injury Patient Paperwork - Spanish (PDF)
  6. Physical Examination Paperwork (PDF)
  7. DOT Exam Paperwork OMB No. 2126-0006 (PDF)
  8. Medical Records Release Form (PDF)
  9. HIPAA Privacy Practices (PDF)
  10. HIPAA Privacy Practices - Spanish (PDF)
  11. Pinnacol First Fill Form (PDF)
  12. Certificate of Physical and Mental Fitness CCD (PDF)