Forms & Resources


Return-To-Work Form

With every medical appointment, a doctor’s opinion regarding activity restrictions is required. Please take this form to your medical appointment and ask the office to fax it to 605-333-9835.

Travel Log

Mileage may be allowable for your out-of-town travel. Contact your adjuster to see if you qualify! Then, log your trips and submit this form to your adjuster.

Medical Authorization Form-HIPAA

Please complete and sign this form allowing our office to have access to your medical records which document the claimed injury.

First Report of Injury Form 

The First Report of Injury is required by the State of South Dakota when filing a workers’ compensation claim. The form is completed by the injured employee and their employer. The employer then submits the form to Claims Associates, who files it with the Department of Labor and Regulation.

Request a Form

Call us at 605.333.9810 or fill out the form below.

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