Email * * geklawcom form 2025

1. Click ‘Get Form’ to open it in the editor.
2. In the 'Employee' section, enter your name and address clearly. This information is crucial for identification.
3. Next, specify the name of your personal physician or medical group in the designated field. Ensure that this doctor meets the requirements outlined in the form.
4. Fill in the street address, city, state, and ZIP code of your chosen physician or medical group accurately.
5. Provide the telephone number of your physician for any necessary follow-up communications.
6. Sign and date the form at the bottom to confirm your choice of physician for work-related injuries.
7. If applicable, have your physician sign and date their agreement to this predesignation. If they do not sign, be prepared to provide alternative documentation.

Start using our platform today to fill out your forms online for free!