Forms and Documents

This page gives you access to key forms that are required for treatment in a Concentra Medical Center.

Necessary Forms

• Employer Authorization Form – We must have a completed and signed Employer Authorization Form for any patient coming to a Concentra Medical Center for treatment of a first-time or new injury. This can happen in two ways:
  • The patient presents it to the receptionist on arrival
  • The employer/supervisor faxes a completed and signed form to the treating center to hold on file until the patient arrives for treatment
  This authorization form – completed and signed – is crucial: we cannot treat patients without it.
• Patient Information Form – Every patient must complete and sign this form for his/her visit. The completed form is permanently filed in the patient’s chart. This form – available in both English and Spanish versions – may be printed and completed in advance, or a copy will be made available when the patient/employee arrives at a Concentra location.

Other Important Documents

• Photo Identification – All patients must show us their photo identification before treatment. Acceptable photo identifications include a driver’s license, work badge, or passport.

Treating Minor Age Patients

A parent or legal guardian should accompany the minor. If you are not the legal guardian, you will need a notarized statement signed by a parent or the legal guardian authorizing you to give permission for services and billing, if appropriate.

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