Discover our exclusive offerings: DOT Physicals for only $85 and Immigration Physicals for an unbeatable $200.* Labs and vaccines are additional.
CALL US TODAY | (949) 207-3786
Schedule your appointment today!
Call Our Center
Contact us for up to date information
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.
Company Name
Employee Name
Authorizing Contact
Authorizing Contact Email
Date
Time
Services Required
Does this employee require injury treatment? Does this employee require injury treatment? Yes No
WC Payor - 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. - 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.
Contact Name
Contact Email
Contact Phone Number
Employee Size
Services Needed
Preferred Date/Time to Contact
How Can We Help?
CALL US | (949) 207-3786
Pay Your Bill
AFC Ladera Ranch
Schedule your appointment
Call (949) 207-3786 for more information about our Ladera Ranch urgent care services.