Forms Your Employee May Need

Treatment Authorization from the Supervisor

Workers' Compensation Registration Form

New Employer Account Information (See #2 below)

Form 19

Items Your Employee needs to bring:

1. Authorization from his or her supervisor approving that the injury was work related. Please include supervisor name, company name, address, and telephone number.

2. If your company does not have an account set up with our office please have someone available that we can call to receive your workers compensation insurance information.

We are here to:

*Assist you in completing any necessary paperwork to satisfy the N.C. Industrial Commission. (


Call and ask for our Workers' Compensation staff if you have any questions at 336-299-0012

On the job injuries are an unfortunate fact of business life. We are fully prepared to treat most injuries that occur while working. We  are also able to perform a wide range of post accident testing and screening. Remember….job-related accidents and illness receive immediate attention.

Savings in medical care by treatment at Urgent Medical & Family Care rather than by a hospital emergency department will reduce cost.  Since no appointment is necessary, your employee returns to the job more quickly, saving your company valuable lost time.


We want to be your company doctor.



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