Telemedicine Authorization
Employees of registered companies now have access to 24/7 care through Agile's Telemedicine program.
Please register an injured or ill employee by filling out the form below.
ONLY FILL OUT THIS FORM AS DIRECTED BY YOUR SUPERVISOR
Instructions
- Complete this Telemedicine Treatment Authorization form and click “Submit Form” at the bottom.
- Contact Agile Occupational Medicine at (424) 292-3260 during normal business hours Monday-Friday 8:30AM – 5:30PM, to complete theregistration process and initiate.
- After hours, call 888-84TELEMED (888-848-3536) to speak with the on-call physician to complete theregistration process and initiate the telemedicine visit.
- Click on the link sent to the patient’s email or cell phone or from the designated email or cell phone.
- Enter name and date of birth to confirm identity and then securely connect to an occupational medicine doctor.
Registration Assistance
If an injury is a life-threatening emergency, please dial 911 or send the injured worker to your local emergency room or hospital.
Paper Registration
If a supervisor referring an employee for a telemedicine appointment prefers filling out a paper/PDF form please click below to download.