MED7® Employer Forms

For the convenience of our patients, here are some of more common forms we use at MED7@ Urgent Care.  They are available for download in the PDF format.

MED7@ Forms

This form may be printed and used to direct an injured worker to the nearest MED7@ clinic. It has a convenient map, hours of operation and telephone numbers, and a listing of services. MED7@ maintains a database of routine services for your company. We realize those services may need to be altered on a case-by-case basis. This form can be used for that purpose.

This form is used to set-up an account for pre-employment services. Once completed, please fax to (916) 483-1937. A representative will contact you shortly.

This form is used to designate MED7@ as the facility of choice for your injured workers. Please complete and fax to (916) 483-1937. A representative will contact you shortly.

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