Workplace Forms

Authorization to Treat Form

If you are sending an employee in to Newport Urgent Care for any sort of treatment, please complete this form.

Download and Print Form

 

WorkComp Insurance Information

If you are sending an employee in to Newport Urgent Care for a workplace injury, please complete this form.

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Commercial Driver Fitness Determination

If you are sending a Commercial Driver for a Medical Examination Report to determine fitness,   please complete this form.

Download and Print Form

In order to release Health Care information, the following form must be filled out:

Authorization to Release Health Care Information