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Treatment Locations and Authorization Forms

Treatment Locations and Authorization Forms

Please select your state.

Connecticut

AFC Urgent Care Authorization Form
AFC Urgent Care Locations

Georgia

Lithia Springs Doctors Panel Location

GA Panels of Physician Compliance

Illinois

Physicians Immediate Care Authorization Form

Physicians Immediate Care Locations

Indiana

Indianapolis - Concentra Authorization Form

Indianapolis - Concentra Indiana Locations

Crawfordsville - Franciscan Indiana Locations

Crawfordsville - Franciscan Authorization Form

New Jersey

CityMD Injury and Illness Call In Procedure

CityMD New Jersey Locations

Rhode Island

AT Med Authorization Form
AT Med Treatment Center Locations

Texas

Concentra Authorization Form

Concentra Texas Locations

Wisconsin

Beloit & Darien - Mercy Authorization Form - Wisconsin
Beloit & Darien - Beloit Health System Location
Beloit & Darien - Mercy Health Location
Kenosha - Concentra Authorization Form
Kenosha - Concentra Wisconsin Locations

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  • 150 E Pierce Rd., Suite 260,
    Itasca, IL 60143
  • Phone: 630-250-7333
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