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 or are registering more than 10 employees at one time for the same clinic, 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.