This form should be completed by the employer before an employee visits an ExpressMED/BOAC location for an Occupational Medicine service. This form ensures accuracy and efficiency in treating our Occ Med patients.
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Do you use ExpressMed/BOAC’s Employer Request Service form? Utilizing our form ensures that your employee will receive only services that are approved by you, the employer. In fact, we guarantee it! What does our guarantee mean for you?
GUARANTEE: If we perform any service that was not specified on the Employer Request Service form submitted by an employer prior to or at the time of service, the entire service will be at NO CHARGE.
We make our very best effort to contact an employer for verification when an employee arrives without an Employer Request Service form. However, this may increase the wait time for your employee while we attempt to verify services needed and permission to perform. We strongly urge employers to send their employees in with a completed form to allow for a seamless visit—for your employee and you as the employer.
CLICK on the form above to access and download ExpressMed/BOAC’s form. If you have any questions please contact your local practice manager or your account manager.