Treatment Locations and Authorization Forms
Please select your state.
Authorization for Examination or Treatment
Arizona Work Injury Clinic Locations – MBI Inc
Concentra
Banner Urgent Care
MBI Authorization Form
AFC Urgent Care Authorization Form
AFC Urgent Care Locations
Patients First Authorization Form
Albany Doctors Panel Locations
Lithia Springs Doctors Panel Locations
Thomasville Doctors Panel Locations
GA Panels of Physician Compliance
Georgia Panel – McDonough
Kentucky Authorization From
Kentucky Clinic Location
Belvidere Ortho Illinois Authorization Form
Local MD Fillable Med Auth Form
Occupational Health Services all Locations
Physicians Immediate Care Authorization Form
Physicians Immediate Care Locations
Work injury Care Zion
Indianapolis – Concentra Authorization Form
Indianapolis – Concentra Indiana Locations
Crawfordsville – Franciscan Indiana Locations
Crawfordsville – Franciscan Authorization Form
Deaconess – Authorization Form
Deaconess – Clinic Locations
Evansville – Mercy Indiana Locations
Evansville – Mercy Indiana Authorization Form
Concentra SMD Contractor Location Listing
Henry Ford Health Authorization Form
Lansing Sparrow Heath Authorization Form
Lansing Work Health Authorization Form
Lansing Memorial Healthcare Authorization Form
Mississippi Choice of Physician’s Form
Mississippi Authorization From
Mississippi Clinic Location
CityMD Injury and Illness Call In Procedure
CityMD New Jersey Locations
Fremont – Promedica360 Health Authorization Form
Hometown Urgent Care Authorization Form
Minster – Hometown Urgent Care Locations
Toledo Area – Concentra Authorization Form
Toledo Area – Great Lakes Urgent Care Authorization Form
Toledo Area – Northwest OH Urgent Care Authorization Form
Concentra Authorization Form
Pennsylvania Physicians Panel Indiana
Pennsylvania Physicians Panel Gap
Pennsylvania Physicians Panel Hazle Township
Pennsylvania Physicians Panel Levittown
Pennsylvania Physicians Panel Lititz
Pennsylvania Physicians Panel Pittston
Pennsylvania Physicians Panel Wilkes Barre
AT Med Authorization Form
AT Med Treatment Center Locations
Tennessee Choice of Physician Form
Concentra Memphis
AFC Memphis
AFC Authorization Form
Baptist Minor Medical Center – Memphis | Walk-In Clinic
Concentra Texas Locations
Beloit & Darien – Mercy Authorization Form – Wisconsin
Beloit & Darien – Beloit Health System Location
Beloit & Darien – Mercy Health Location
Froedert South – Locations
Froedert South – Authorization Form
Kenosha – Concentra Authorization Form
Kenosha – Concentra Wisconsin Locations