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

▾ Download in English

Company Data Sheet

▾ Download in English

Medical Authorization

▾ Download in English

On-site Service Request

▾ Download in English

Workers’ Compensation Forms

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

 Download in English
 Descargar en Español

Employee’s Claim for Compensation/Report
of Initial Treatment Form C-4

▾ Download in English

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.