Corporate Account

Thank you for choosing CareNow
To set up your Occupational Medicine account, please fill out the following information.
Your designated Marketing Representative will contact you shortly thereafter to verify your account
is active and answer any questions you may have regarding your company's specific protocol.

* are required fields.

Company Name:	*
Address:	*
PO Box(if applicable):
City:	*
State:	*
Zipcode:	*
Phone:	*
Fax:
Contact Name:	*
Title:
Email Address:
Best phone number to reach you:

Services Needed:

Work related injury care Drug testing Pre-Employment services

Additional Information:

For questions, please contact our Occupational Marketing Department at 972-745-7500, Option 3.
Or you can dial "0" and let the operator know you need to speak with an Occupational Marketing
representative. You are also welcome to email us for more information at occmed@carenow.com
We will be happy to assist you.