Employer Resources
Employer forms
Use these forms to authorize treatment of an injured or sick employee as well as to open an account with your clinic and establish a payment method.
Please email forms to customercare@akesomedical.com
El Centro Clinic
Forms
TREATMENT
AUTHORIZATION
Autorización para tratar
TREATMENT
AUTHORIZATION
Fill out /Print
EMPLOYER
QUESTIONAIRE
Cuestionario de empleo
EMPLOYER
QUESTIONAIRE
Fill out /Print
CREDIT CARD
AUTHORIZATION
Autorización de crédito
CREDIT CARD
AUTHORIZATION
Fill out /Print
Workplace Notices
IN CASE of INJURY
WALL SIGN
IN CASE of INJURY
WALL SIGN
Fill out /Print
Huntington Beach Clinic
Forms
TREATMENT
AUTHORIZATION
Autorización para tratar
TREATMENT
AUTHORIZATION
Fill out /Print
EMPLOYER
QUESTIONAIRE
Cuestionario de empleo
EMPLOYER
QUESTIONAIRE
Fill out /Print
CREDIT CARD
AUTHORIZATION
Autorización de crédito
CREDIT CARD
AUTHORIZATION
Fill out /Print
Workplace Notices
IN CASE of INJURY
WALL SIGN
IN CASE of INJURY
WALL SIGN
Fill out /Print
Irvine Clinic
TREATMENT
AUTHORIZATION
Autorización para tratar
TREATMENT
AUTHORIZATION
Fill out /Print
EMPLOYER
QUESTIONAIRE
Cuestionario de empleo
EMPLOYER
QUESTIONAIRE
Fill out /Print
CREDIT CARD
AUTHORIZATION
Autorización de crédito
CREDIT CARD
AUTHORIZATION
Fill out /Print
Workplace Notices
IN CASE of INJURY
WALL SIGN
IN CASE of INJURY
WALL SIGN
Fill out /Print
Napa Clinic
TREATMENT
AUTHORIZATION
Autorización para tratar
TREATMENT
AUTHORIZATION
Fill out /Print
EMPLOYER
QUESTIONAIRE
Cuestionario de empleo
EMPLOYER
QUESTIONAIRE
Fill out /Print
CREDIT CARD
AUTHORIZATION
Autorización de crédito
CREDIT CARD
AUTHORIZATION
Fill out /Print
Workplace Notices
IN CASE of INJURY
WALL SIGN
IN CASE of INJURY
WALL SIGN
Fill out /Print
National City Clinic
TREATMENT
AUTHORIZATION
Autorización para tratar
TREATMENT
AUTHORIZATION
Fill out /Print
EMPLOYER
QUESTIONAIRE
Cuestionario de empleo
EMPLOYER
QUESTIONAIRE
Fill out /Print
CREDIT CARD
AUTHORIZATION
Autorización de crédito
CREDIT CARD
AUTHORIZATION
Fill out /Print
Workplace Notices
IN CASE of INJURY
WALL SIGN
IN CASE of INJURY
WALL SIGN
Fill out /Print
Oxnard Clinic
TREATMENT
AUTHORIZATION
Autorización para tratar
TREATMENT
AUTHORIZATION
Fill out /Print
EMPLOYER
QUESTIONAIRE
Cuestionario de empleo
EMPLOYER
QUESTIONAIRE
Fill out /Print
CREDIT CARD
AUTHORIZATION
Autorización de crédito
CREDIT CARD
AUTHORIZATION
Fill out /Print
Workplace Notices
IN CASE of INJURY
WALL SIGN
IN CASE of INJURY
WALL SIGN
Fill out /Print
Santa Fe Springs North Clinic
TREATMENT
AUTHORIZATION
Autorización para tratar
TREATMENT
AUTHORIZATION
Fill out /Print
EMPLOYER
QUESTIONAIRE
Cuestionario de empleo
EMPLOYER
QUESTIONAIRE
Fill out /Print
CREDIT CARD
AUTHORIZATION
Autorización de crédito
CREDIT CARD
AUTHORIZATION
Fill out /Print
Workplace Notices
IN CASE of INJURY
WALL SIGN
IN CASE of INJURY
WALL SIGN
Fill out /Print
Santa Fe Springs South Clinic
TREATMENT
AUTHORIZATION
Autorización para tratar
TREATMENT
AUTHORIZATION
Fill out /Print
EMPLOYER
QUESTIONAIRE
Cuestionario de empleo
EMPLOYER
QUESTIONAIRE
Fill out /Print
CREDIT CARD
AUTHORIZATION
Autorización de crédito
CREDIT CARD
AUTHORIZATION
Fill out /Print
Workplace Notices
IN CASE of INJURY
WALL SIGN
IN CASE of INJURY
WALL SIGN
Fill out /Print
Santa Maria Clinic
Forms
TREATMENT
AUTHORIZATION
Autorización para tratar
TREATMENT
AUTHORIZATION
Fill out /Print
EMPLOYER
QUESTIONAIRE
Cuestionario de empleo
EMPLOYER
QUESTIONAIRE
Fill out /Print
CREDIT CARD
AUTHORIZATION
Autorización de crédito
CREDIT CARD
AUTHORIZATION
Fill out /Print
Workplace Notices
IN CASE of INJURY
WALL SIGN
IN CASE of INJURY
WALL SIGN
Fill out /Print
For more information, please contact us at info@akesomedical.com