Personal Physician Designation Form

Use this form for an employee to elect to receive medical treatment from his personal physician in case of an industrial injury or illness. Employers are required by law to provide all employees with an opportunity to pre-designate a physician for purposes of medical treatment in the event of a workplace injury. The form provides employees with notice of their rights and their doctor’s consent.

 Product Features

• Easy-to-use, fill-in-the-blank format
• Downloadable, RTF file for you to personalize
• Sample form