Get Dwc Form 9783.1 (7/2014) - Personnel Department - City Of Los ... - Personnel Lacity

Filling out the DWC FORM 9783.1 is an essential step for notifying your employer about your choice of personal chiropractor or acupuncturist following a work-related injury or illness. This guide will provide clear instructions on how to complete the form online.

Follow the steps to successfully complete and submit the form.

1. Press the ‘Get Form’ button to access the form and open it in the document editor.
2. In the section labeled 'Your Chiropractor or Acupuncturist's Information,' fill in the name of your personal chiropractor or acupuncturist in the designated field.
3. Provide the complete street address, including city, state, and zip code of your chiropractor or acupuncturist. Ensure the accuracy of this information to avoid delays.
4. Enter the telephone number of your chiropractor or acupuncturist in the specified field. This contact detail may be necessary for follow-up questions.
5. Print your name in the 'Employee Name' section to officially identify yourself as the person submitting the form.
6. Next, write your address in the 'Employee's Address' section, ensuring it is current and correct.
7. Sign and date the form in the respective fields. Your signature is necessary for verifying the submission.
8. Once the form is fully completed, you can choose to save changes, download, print, or share the document as needed.

Complete your documents online today for a smoother process.