PATIENT FORMS

MAKING SURE YOUR VISIT IS AS SMOOTH AS POSSIBLE

NEW PATIENT FORM

First time here? Fill out these forms and bring them to the clinic with you:

Coming from another clinic? Fill out this form:

Please note that in addition to the form above, we will need a complete copy of your records of treatment for your injury (easiest to get these from your insurer) before we can determine if we can get you scheduled with one of our providers.

UPDATE YOUR INFORMATION

PATIENT Update forms:

To inform us of changes, and/or to review paperwork you should have filled out at your first visit:

CDL-SPECIFIC FORMS

FOR CDL HOLDERS:

 

CMV DRIVER MEDICATION FORM Please bring this completed form with you to your appointment

CDL-Insulin (For Insulin-dependent drivers) Please bring completed forms with you to your appointment.

Yakima Worker Care- 409 S. 12th Ave, Yakima, WA 98902

Sunnyside Worker Care- 1614 E. Edison Ave. STE E, Sunnyside, WA 98944

Tel:  Yakima- 509-575-2949

Tel: Sunnyside- 509-836-0075

Fax: 509-575-5743

Employer accounts Tel: 509-575-3677

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© 2021 by Worker Care.