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Home > Health Resources > Urgent Care

Health
Resources

URGENT CARE
Save 60% By Visiting An Urgent Care
URGENT CARE
Save Time and Money with Urgent Care
URGENT CARE
Immunizations: Why, Which & Where
URGENT CARE
You Can Stay Fit During the Holidays
URGENT CARE
Care During Stay At Home Orders
URGENT CARE
We Can Handle 80% of Your Emergency Medical Needs
URGENT CARE
Emergency Room Vs Urgent Care

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Interested in learning more about selling your practice or joining the NextCare family of brands? Complete the form below, and we will be in touch shortly. You can also email us at contactus@nextcare.com

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Name

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Business Name

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Number of employees:

1-50

50-100

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Number of locations:

Do these protocols apply to all locations?

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Primary Contact Name

First Last

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Secure Fax

Is your billing address the same as your physical address?

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Billing Contact Name

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Billing Contact Address

Street Address Address Line 2 City State

Billing Contact Email

Billing Contact Phone

Would you like to list a secondary contact?

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Secondary Contact Name

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Secondary Contact Job Title

Secondary Contact Fax

Will your company use NextCare for the treatment of work related injuries?

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Insurance Carrier Name

Address

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Policy Number

Phone

How would you like the work statuses reported?

Fax

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Send with Employee

Company Contact

Same as primary

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Name

First Last

Phone

Email

Any additional comments or special instructions?

Will your company use NextCare for drug testing?

No

Yes

Drug screen services are billed to:

Company

Third Party Administrator (TPA)

Candidate/Employee

Name of TPA

Who is the Designated Employer Representative?

Primary Contact

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Type

DOT / Federal

Federal

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HHS

NRC

DOT Agency

FMCSA

FAA

FRA

FTA

PHMSA

USCG

Lab and Medical Review Officer Services (MRO):

Full Service (use NextCare’s Lab and MRO)

Collection Only (use your company’s existing Lab Account and MRO)

Drug Screen Collection Method:

Urine

Hair

Saliva

Other

Testing Type:

*Rapid testing is not available in our Kansas market. Non-negative rapid test results are sent-out to lab for confirmatory testing and MRO review prior to result reporting.

Send-out to laboratory for testing (results available in 3-5 days)

Rapid / Quick Test (negative test results available same day)*

Rapid / Quick Test Panels:

5 Panel Rapid

11 Panel Rapid

Other

Send-Out Panels:

5 Panel

9 Panel

10 Panel

12 Panel

Other

Would your company be interested in learning about NextCare’s random management program?

Yes

No

Name of Lab

Lab Account Number

Reason for Test:

Pre-Employment

Random

Return to Work

Reasonable Suspicion

Post Accident

Follow-Up

Secured Method of Reporting

Fax

Email

Additional Notes/Comments:

Would you like to add another drug screen to your account?

Yes – An Occ Health Team Member Will Follow Up For More Details

No

Will your company use NextCare for physical examinations?

No

Yes

Basic Physical (includes vitals, review of medical history and physical exam)

DOT Physical

Return To Work

Other

Physical Services are billed to:

Company

Third Party Administrator (TPA)

Candidate/Employee

Name of TPA

Authorized recipients:

Primary Contact

Secondary Contact

Other

Name

First Last

Phone

Secure Fax

Email

NextCare offers many other Occupational Health services, please use this box to list any other testing, vaccines, lab testing or other services you may need.

Find Your Location
- Arizona
- Colorado
- Kansas
- Michigan
- Missouri
- North Carolina
- Oklahoma
- Nebraska
- Texas
- Virginia
- Wyoming
Plan Your Visit
What We Treat
Health Resources
Occupational Health