Employer Forms for WellNow Urgent Care

Medical Insurance W-9

(This will be used for Worker’s Compensation Carriers and Medical Insurances purposes for patients treated at any of our Michigan, Ohio, Indiana Wellnow Locations.)

Occupational Medicine Employer W-9

(This will be used for any Companies whose Employees received Occupational Medicine services at any of our Michigan, Ohio, Indiana Wellnow Locations.)

Medical Insurance W-9

(This will be used for any Worker’s Compensation Carriers and Medical Insurance purposes for patients treated at any of our New York and Illinois Locations.)

Occupational Medicine Employer W-9

(This will be used for any Companies whose Employees received Occupational Medicine services at any of our New York and Illinois Wellnow Locations.)

New York is a no-fault insurance state and patients must sign a no-fault form to assign benefits to the provider.

dba WellNow Urgent Care

P.O. BOX 1848

Albany, NY 12201-1848