PromptMed Employer Forms

Occupation Health/Employer Forms

Before sending your employee(s) to PromptMed, the following required forms must be completed:

Employer Authorization Form
PromptMed must have authorization in order to treat your employee(s) for any pre-employment services or treatment of first-time injury. Please click on link and complete authorization form. Employers may submit authorizations to PromptMed in of the following methods:

fax 812-372-8964
employees may hand deliver at arrival to office.

EMPLOYER AUTHORIZATION FORM

Occupational Health Registrations Form
For faster service, please refer your employee(s) to our website to download, complete and print registration forms prior to their visit.

OCCUPATIONAL HEALTH REGISTRATION FORM

Important Notice: All employees must present photo identification before treatment. Acceptable forms of identification are: driver's license, passport, work badge with photo, school ID with photo.

Are you a new client/employer with PromptMed? A company protocol must be established with PromptMed prior to sending your employee. Please contact our office to set up a company protocol.

If you have questions about any of the forms, we'll be happy to assist you when you visit our office.