
Pre-Authorization Form Worker's and Physician's Report for Workers' Compensation Claims. Please enter the following information to pre-authorize your employees, helping us provide quality immediate care.
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Company Information
Company Name*
Address*
Suite/Bldg
City*
State*
Zipcode*
Fax*	() -


HR Contact
First Name*
Last Name*
Email*
Phone*	() - ext


Insurance Information
Workers' Comp Ins*
Address*
Suite/Bldg
City*
State*
Zipcode*


Additional Information

Sherwood Urgent Care & Medical Center | Contact Us

Office Information

Monday—Friday, 11:00 a.m. to 9:00 p.m.
Saturday 9:00 a.m. to 5:00 p.m.
Sunday 12:00 p.m. to 5:00 p.m.

Sherwood Urgent Care & Medical Center
21319 SW Sherwood Blvd.
Sherwood, Oregon 97140
Office: (503) 625-4100

Email: info@sherwoodurgent.com

Click here for Directions

Pre-Authorization Form

Company Information

HR Contact

Insurance Information

Additional Information

Office Information