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In order to be eligible to make this change, you must give your employer the name and business address of a personal chiropractor or acupuncturist in writing prior to the injury or illness. Your employer will then complete the.The NOTICE OF PERSONAL CHIROPRACTOR OR PERSONAL ACUPUNCTURIST If (California) form is 1 page long and contains: 1 signature; 0 check-boxes; 7 other fields. You may use this form to notify your employer of your personal chiropractor or acupuncturist. Give this form to any employee who wants to pre-designate a chiropractor or acupuncturist as treating doctor for work-related injuries. Minimize the risk of using outdated forms and eliminate rejected fillings. Therapy and chiropractic care. If your employer has a workers' compensation Medical Provider Network. (MPN), you may only switch to a personal chiropractor or acupuncturist within the MPN. Complete the employee portion, sign and give it back to your employer.