Have an established account with us? Please fill out the form below, or click here to download a blank form. If you need to set up an account, please contact our Occupational Health Sales Team: 847-257-5616.

If you have encountered any problems with our website or the Medical Authorization form, please contact our Webmaster.

Please note:  Patient Must Present Photo ID at Time of Service.  Please check the individual clinic pages for any temporary changes in clinic hours during the pandemic.