Employer Resources

Employer forms

Use these forms to authorize treatment of an injured or sick employee as well as to open an account with your clinic and establish a payment method.

Please email forms to customercare@akesomedical.com

Huntington Beach Clinic

Forms

TREATMENT

AUTHORIZATION

 

Autorización para tratar

TREATMENT

AUTHORIZATION

 

Fill out /Print     

EMPLOYER

QUESTIONAIRE

 

Cuestionario de empleo

EMPLOYER

QUESTIONAIRE

 

Fill out /Print     

CREDIT CARD

AUTHORIZATION

 

Autorización de crédito

CREDIT CARD

AUTHORIZATION

 

Fill out /Print     

Workplace Notices

IN CASE of INJURY

WALL SIGN

 

 

IN CASE of INJURY

WALL SIGN

 

Fill out /Print     

Irvine Clinic

Napa Clinic

National City Clinic

Oxnard Clinic

Santa Fe Springs North Clinic

Santa Fe Springs South Clinic

For more information, please contact us at info@akesomedical.com