Manage Your Performance and Costs

Order WCB Health Care Provider Forms:

Order WCB Health Care Provider forms and booklets electronically by simply filling in the fields below.

Occasionally our forms and brochures change, so make sure you have the newest version by ordering only the stock you require.

Note: * indicates a required field

*Contact Name:
*Phone Number:
 with area code
*Company Name:
 E-mail Address:
*Mailing Address:
postal code

Please print the available PDF if your order is under 10 forms.
Physician Quantity
C050 Physician's First Report (not available for download)
C151 Physician's Invoice & Report (not available for download)
C459 Physician's Completion Guide - Print (pdf, 1.11 MB)
C568 Medical Invoice - Print (pdf, 65KB) [Limit of 300]
C569 Medical Supplies Invoice - Print (pdf, 8KB)
C570 Medical Invoice Correction - Print (pdf, 50KB)
Physical Therapy Quantity
C773 Physical Therapy Clinic Authorization to Release Medical Information - Print (pdf, 55KB)
Occupational Disease Quantity
C117 Worker's Employment Record (Chemical Exposure) - Print (pdf,35KB)
C684 Cardiac Questionnaire - Print (pdf, 23KB)
C013 Pulmonary History Questionnaire - Print (pdf, 27KB)
C437 Dermatitis Questionnaire - Print (pdf, 23KB)
Occupational Therapy Quantity
C695 Occupational Therapy Report - Print (pdf, 34KB)
Prosthetic and Orthotic Quantity
C537 Prothetist's /Orthotists' Invoice & Report - Print (pdf, 65KB)
C998 Prosthetic and Orthotic Services Assessment - Print (pdf, 21KB)
Medical Specialist Quantity
C690 Hand Clinic Assessment Report - Print (pdf, 29KB)
C691 Hand Clinic Status Report - Print (pdf, 34KB)
Acupuncture Quantity
M007 Acupuncture First Report
M007A Acupuncture Progress / Discharge Report - Print (pdf, 11KB)
M007B Acupuncture Invoice - Print (pdf, 11KB)
Hearing Aid / Audiologist Quantity
C659 Hearing Program Invoice - Print (pdf, 29KB)
C660 Travel Reimbursement - Print (pdf, 20KB)
C662 Hearing Loss Assessment - Print (pdf, 37KB)
C972 Hearing Loss Authorization - Print (pdf, 17KB)
Hearing Loss Package - Print (pdf, 95KB)
Dental Quantity
C055/C887 Dental Report - Print (pdf, 39KB)
C616 Dental Guide - Print (pdf, 147KB)
C617 Denturist Guide - Print (pdf, 141KB)
C884 Denturist Report - Print (pdf, 59KB)
General Quantity
Box of 500 Health Care Services Survey Return Envelopes
Call 780-498-3999 if additional information is required.

If you see this, leave this form field blank and invest in CSS support.