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Workers Compensation

For employers, please complete Steps 1, 2 & 3. When coming to their visit, employees should have all three forms on hand. Or, they can be faxed before hand to (805) 379-2311.

For employees, please be sure to have your employer complete the required forms prior to coming to your appointment.

Step 1

State of California, Workers Compensation Claim Form (DWC 1) & Notice of Potential Eligibility.

Step 2

Westlake Village Urgent Care Occupational Health Program, Company Profile.

Step 3

Westlake Village Urgent Care Occupational Health Program, Reason for Visit.

Step 4

**Health Care Facilities Only**
LIC503 Health Screening Report Form.

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