Request Services for Your Company

Tell us what your company needs and the occupational health team will follow up to set up your account or answer your question. This form is for employers, carriers and case managers — it is not for medical information about an employee, which is collected at the visit.

What to include

• Company name, your name and role, and the best phone number and email.
• Which services you use or want to set up: physicals, DOT exams, drug and alcohol testing, injury care, screenings.
• Roughly how many employees, and whether you need a standing workers’ compensation authorization.
• How you want results and reports delivered, and to whom.

Tell us about your company

Tell us about your company and the services you need. We reply the same business day.

Website

Company

Company name *

Industry / business type

Company website

Company address *

City *

State *

ZIP code *

Main phone number *

Number of employees *Select…1–1011–2526–5051–100101–250250+

Your contact information

First name *

Last name *

Job title

Email address *

Direct phone number *

Preferred contact method *Select…PhoneEmailEither

Services & timeline

Services needed

Workers' Compensation Injury Care Workplace Injury Evaluation DOT Physicals DOT Drug Testing Non-DOT Drug Testing Breath Alcohol Testing / BAT Pre-Employment Physicals Fit-for-Duty Evaluations Return-to-Work Evaluations Work Status Documentation TB Screening Respirator Mask-Fit Testing Employer Medical Clearance Random Testing Program Support Post-Accident Testing Other Employer Service

Preferred clinic

Davie Plantation No preference

How soon are services needed? *Select…TodayThis WeekWithin 2 WeeksOngoing Employer Account SetupNot Sure

Is this related to a workplace injury?Select…YesNoNot Sure

Is this related to DOT/FMCSA requirements?Select…YesNoNot Sure

Message / service notes

I agree to be contacted about this request. *

Please do not include medical details, symptoms, or insurance information in this form. For care, check in online or call.

Send request

Need an employee seen today?

Do not wait for a reply — call the clinic nearest the employee and tell the front desk they are coming. UrgentMed Davie (5149 S University Drive, off I-595) and UrgentMed Plantation (10199 Cleary Boulevard, near Nob Hill Road) are both open seven days a week; send the treatment authorization with the employee. The full list of services is on the employer services page.

What an account usually covers

Most Broward employers set one up for the same handful of things: DOT and CDL medical exams, pre-employment physicals, DOT and non-DOT drug and alcohol testing with certified collectors on site, occupational screenings including TB testing and respirator fit testing, workers’ compensation injury care with the DWC-25 completed at every visit, and fit-for-duty and return-to-work evaluations. Carriers and third-party administrators we already bill are listed under workers’ compensation insurance, and adjusters and case managers have their own page.

One account covers both clinics — Davie and Plantation — so employees go to whichever is closer to the job site, and reports reach the same designated contact either way. Employers across Davie, Plantation, Cooper City, Sunrise, Weston, Southwest Ranches and Fort Lauderdale use the same setup.