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Occupational Health Authorization & New Business Form

Welcome employers! Please fill out the form needed below.

New Companies: If you are inquiring about starting an account, please complete the New Company Form below.

If you prefer a paper authorization form, please CLICK HERE. Please link the PDF attached.

Authorization Form

- Please provide your WC info if you would prefer that we bill your insurance. If your company would like to be billed directly, please input BILL DIRECT.

New Business Form

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