BEmployer Authorization Formb 2026

1. Click ‘Get Form’ to open the Employer Authorization Form in the editor.
2. Begin by filling in the 'Employer' field. If applicable, indicate whether you are using a staffing agency by selecting 'Yes' or 'No'. If 'Yes', provide the name of the agency.
3. In the 'Authorized By' section, print and sign your name to confirm authorization.
4. Complete the employee's details including their name, address, social security number, email, and date of birth (DOB).
5. For the 'Reason For Visit', check all applicable options such as Work Related, Injury, or Substance Abuse Testing. Provide specific details where necessary.
6. If substance abuse testing is required, specify the type and reason for testing from the provided options.
7. Fill in any additional procedures needed and include billing information if applicable.
8. Lastly, add any specific instructions or comments that may be relevant to the visit.

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