Claims Administration

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Adjuster Portal

Our Adjuster portal gives you instant access to your Work Status Reports and much more, all at your fingertips in a HIPAA secure portal!

I’m Already Set Up

I Don’t Have Portal Access And Need A Work Status Report

Telehealth Request

Clinic Forms

Click on a link below to access useful tools for you and your employees:

Employer Authorization Form

Map & Directions

In Case of Injury (ENGLISH)

In Case of Injury (SPANISH)

Business Documents

Click on a link below to access necessary business documents:

Tax ID Change Notification – Effective January 1, 2018

Clinic Locations and Billing/Remittance Address

W9 - 2022 (Effective For Dates Of Service On Or After January 1, 2022)

W9 – 2021

OSHA Respirator Surveillance Forms

Click on a link below to access the appropriate questionnaire based on the type of mask being worn:

OSHA Respirator Questionnaire for Non-Full-Face and Non-SCBA Respirators (English)

OSHA Respirator Questionnaire for Non-Full-Face and Non-SCBA Respirators (Spanish)

OSHA Respirator Questionnaire for Full-Face and SCBA Respirators (English)

OSHA Respirator Questionnaire for Full-Face and SCBA Respirators (Spanish)