After completion of the entire form, please see below for next steps.
Member/Employee: Please call TEAM Corporation at (651) 642-0182 to set up your appointment(s).
Supervisor/Referent: Please provide a copy of UA results to TEAM, if applicable, to (651) 642-1809 or [email protected]
This form must be received in our office prior to scheduling the member/employee’s appointment. For confirmation of contact or attendance at TEAM Corporation, an Authorization for Release of Protected Health Information must be completed and signed by member/employee and submitted. If possible, please complete referral form with the member/employee present and give a copy to the member/employee, then fax/email a copy to TEAM Corporation at (651) 642-1809 or [email protected].
