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How to use or fill out Employer Authorization Form with our platform
- Click ‘Get Form’ to open the Employer Authorization Form in the editor.
- 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.
- In the 'Authorized By' section, print and sign your name to confirm authorization.
- Complete the employee's details including their name, address, social security number, email, and date of birth (DOB).
- For the 'Reason For Visit', check all applicable options such as Work Related, Injury, or Substance Abuse Testing. Provide specific details where necessary.
- If substance abuse testing is required, specify the type and reason for testing from the provided options.
- Fill in any additional procedures needed and include billing information if applicable.
- Lastly, add any specific instructions or comments that may be relevant to the visit.
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