Company Profile Form
The Company Profile form provides a convenient way to add your company to the Occupational Medicine database and establish a set of preferences and protocols for your employees' care. Please fax your completed form to (940) 384-4726 to get started!
Please complete this form for each employee sent to Occupational Medicine. This form states what services are needed for each employee and confirms that they are authorized to be seen at the clinic. The form can be accessed online, printed, and sent with the employee to the Occupational Medicine clinic.