Skip to primary navigation
Skip to main content

Pay Your Bill

Urgent Care and Walk In Clinics

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

Home > Health Resources > Wellness

Health
Resources

WELLNESS
Summer workout tips
WELLNESS
Asthma: Facts & More
WELLNESS
Foot Health: Problems & Solutions
WELLNESS
Stress: What is it?
WELLNESS
Kidney Health & Why It’s Important
WELLNESS
Sleep: Tips & Benefits
WELLNESS
NextCare: COVID-19 Testing Options
WELLNESS
Rapid Testing Process & Benefits
WELLNESS
Virtual Care: How does it work?
WELLNESS
How to keep our New Year’s resolutions
WELLNESS
Holiday Safety Tips
WELLNESS
Healthy Eating: Holiday Tips

‹ 1 … 3 4 5 6 7 ›

Name

This field is for validation purposes and should be left unchanged.

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

Name(Required)

First Last

Company Name

Email(Required)

Phone

Message(Required)

Step 1 of 6

16%

Phone

This field is for validation purposes and should be left unchanged.

Contact Us

Name(Required)

First Last

Company Name(Required)

Email(Required)

Phone(Required)

What State Are Your Inquiring About?(Required)

Arizona

Colorado

Kansas

Michigan

Missouri

Nebraska

New Mexico

North Carolina

Oklahoma

Texas

Virginia

Wyoming

Please Select All That Apply

Austin

DFW East & Waco

DFW West & Abilene

Houston

San Antonio

South Texas

Would like to complete company protocols online or have someone contact you?(Required)

Yes, complete online

No, have someone contact me

Business Name

Legal Business Name (If Differs)

Physical Address

Street Address Address Line 2 City State

Number of employees:

1-50

50-100

100+

Number of locations:

Do these protocols apply to all locations?

Yes

No

Primary Contact Name

First Last

Primary Contact Phone

Primary Contact Alternate Phone

Primary Contact Email

Primary Contact Job Title

Secure Fax

Is your billing address the same as your physical address?

Yes

No

Billing Contact Name

First Last

Billing Contact Address

Street Address Address Line 2 City State

Billing Contact Email

Billing Contact Phone

Would you like to list a secondary contact?

No

Yes

Secondary Contact Name

First Last

Secondary Contact Phone

Secondary Contact Alternate Phone

Secondary Contact Email

Secondary Contact Job Title

Secondary Contact Fax

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

No

Yes

Insurance Carrier Name

Address

Street Address Address Line 2 City State

Policy Number

Phone

How would you like the work statuses reported?

Fax

Email

Send with Employee

Company Contact

Same as primary

Same as secondary

Other

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

Secondary Contact

Other

Type

DOT / Federal

Federal

Non-DOT

Federal

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