This page gives you access to key forms that are required for treatment in a Concentra Medical Center.
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 (Spanish version) — 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.