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Forms for Authorization for Corporate Care Services

Occupational health

Employers and employees must complete the following forms for authorization for Corporate Care services.

In addition to forms below, please be certain to bring photo proof of identification, such as a driver's license or work ID card. Minor employees who need treatment must be accompanied by a parent or legal guardian, or must have a notarized statement from the guardian or parent authorizing the employer to give permission for treatment as needed.

For New Injury or First-Time Visits

We must have authorization from your company/employer to administer treatment without delay.

Employers should provide injured/sick employees with a completed and signed Employer Authorization Form for presentation at the first visit.

Post-Offer Pre-Employment Physical Form

Medemerge
1005 North Washington Avenue
Green Brook, NJ 08812
(732) 968-8900
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Ocean County Hub Corporate Care EHW
1195 Route 70, Suite 1000
Lakewood, NJ 08701
(732) 942-5851
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Jersey City Medical Center Corporate Care EHW
414 Grand Street
Suite 17
Jersey City, NJ 07302
(201) 915-2750
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Union County Hub Corporate Care EHW
240 Williamson Street
Suite 202
Elizabeth, NJ 07202
(908) 994-5368
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RWJ University Hospital Hamilton Corporate Care EHW
2 Hamilton Health Place
Hamilton, NJ 08690
(609) 631-6830
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Monmouth Medical Center Corporate Care EHW
300 Second Avenue
Long Branch, NJ 07740
(732) 923-6745
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Central Jersey Hub Corporate Care EHW
181 Somerset Street
3rd Floor
New Brunswick, NJ 08901
(732) 937-8714
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Newark Beth Israel Medical Center Corporate Care EHW
365 Osborne Terrace
Newark, NJ 07112
(973) 926-7224
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Essex County Hub Corporate Care EHW
101 Old Short Hills Road
Suite 415
West Orange, NJ 07052
(973) 322-6450
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Occupational Medicine and Corporate Care Treatment & Care

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