Employer Forms


 

A+ Occupational Medicine Employer Forms

Below are A+ forms to get you started with our occupational medicine services. Those new to A+ OccMed Care can start off by reading the New Company Paperwork document below to learn all about our policies and procedures. If you would like to sign up your business for A+ OccMed Care, please complete and submit the Company Data Sheet and you will receive a call from an A+ Total Care representative to verify your information.


Submitting Forms

You can download, print, and fill out the forms to be hand delivered in-person at our clinic or send them to us by email.

  • Hand-deliver or mail forms to: 976 Mountain City Hwy in Elko, 89801
  • Send completed forms by email
  • We’re not accepting faxed forms at this time.

For guidance in determining which forms you need to fill out for getting started with A+ OccMed Care services, call the A+ Occupational Medicine Department at 775-777-7587, visit our Employer FAQs page, or send a message to us with your question using our online contact form.


General Employer Forms

New Company Paperwork


Company Data Sheet


Medical Authorization

On-site Service Request

Workers’ Compensation Forms

Employee’s Claim for Compensation/Report of Initial Treatment–C4


Work-related Illness or Injury
Lesión o Enfermedad Relacionada con el Trabajo

Patient Registration Forms

For additional A+ OccMed Care registration forms for your employees, visit our Patient Forms page.

WeCare Medical Discount Program Corporate Membership

Sign up to become a WeCare Medical Discount Program corporate member and save up to 25% on medical visits year-round. Visit our WeCare Program page for more information.

Location
A+ Total Care
976 Mountain City Highway
Elko, NV 89801
Phone: 775-238-4476
Fax: 775.738.9584
Office Hours

Get in touch

775-238-4476