Employer account form

Open an account once and send employees to either clinic without paperwork at the front desk. There is no setup fee, and you receive one invoice a month. See employer prices.

This form is for business and insurance details only. Please do not include employee names, dates of birth or injury details. Next step: send us your workers’ comp insurance details so injured employees never need to bring them.

Company
Contacts
Services you'll use
Services

Billing
Clinic you'll use most

Authorization

Fields marked * are required.