Employer Solutions Inquiry / Industry Accounts Inquiry

Ridgeland - Pearl - Flowood - Clinton - Byram - Laurel

Serving Central Mississippi Since 1993

EMPLOYER SOLUTIONS INQUIRY

From preventive measures, to post injury rehabilitation and safe, sustained return to work duties, we provide an integrated approach to ensuring overall client satisfaction. Our industrial specialists will review your own needs and co-develop programs designed to expedite return to work as well as positively impact future injury costs.

Client Name: *

Today's Date: *

Address:

City:

State

Zip:

Primary Contact Name: *

Preferred Method of Communication: *

Phone

Email

Primary Contact Phone #: *

Primary Contact Email: *

Services Inquiry (select all that apply): *

Services requested to be performed at: *

Genesis Clinic(s)

On-Site of Employer

Both Options

On average, # of employees expected to receive services per month: *

Thank you for submitting your inquiry, a member of our team will be in touch shortly

Pre-Employment Assessments	Injury Prevention Program	Ergonomics Program
Job Demands Analysis	Post-Offer Assessments	Work Conditioning Program
Functional Capacity Evaluation (FCE)	Other Other