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Occupational & Family Medical Clinic
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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