Authorization Form

COMING SOON!

As employers, you may download this authorization form at your own convenience of sending your employee directly in for treatment with the form in hand or it may be faxed directly to our office at: 786-923-4001.  Please fill out the entire top portion regarding pertinent information concerning your company, and check off all boxes that apply to the patients visit.

Example:

If your employee is coming in for an injury, check "work related injury" , then check off whether you would like a drug screen performed at the time services are rendered. 

Make sure to sign and date the bottom of the authorization form, otherwise we will simply call to verify authorization.