Get Wy Urgent Care Of Casper Company Application Form 2023-2025

This guide provides a comprehensive overview of the WY Urgent Care Of Casper Company Application Form, detailing each section to assist you in completing it accurately online. Following these steps will ensure that you provide all necessary information in a clear and organized manner.

Follow the steps to successfully complete the application form.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred online platform or tool.
2. Begin filling in the Company Name, Physical Address, and Mailing Address. Ensure that all addresses are accurate and clearly stated.
3. Provide the main contact person's name, phone number, and email address. This individual will be the primary representative for your company.
4. List who you would like to receive results by entering their names and email addresses. They will be invited to set up their Cowork Health accounts.
5. Enter the Safety/Injury contact's information, including name, phone number, and email address, ensuring all details are correct.
6. Respond to the questions regarding workers' compensation claims by marking 'YES' or 'NO' as appropriate.
7. If your company does not submit to Wyoming Worker’s Compensation, provide the complete billing information requested.
8. Fill in the Billing Contact section with relevant details, including name, phone, and email. This person will handle invoicing.
9. List any requested services as needed. This should reflect the specific services sought by your company.
10. Complete the Drug and Alcohol section by entering the contact details for the DER and authorized personnel for discussing results.
11. Indicate if you use a Third Party Administrator and provide their name and address if applicable.
12. Respond to the questions regarding Chain of Custody forms and provide any necessary details about required testing.
13. Review the entire form for accuracy and completeness. Once satisfied, you can save your changes, download, print, or share the form as needed.

Complete your application form online today for efficient processing.