Excuse the mess, while our site undergoes renovations!
Visit our Virtual Ergonomics Services Page

Multiple Full Assessments (same location)

Choose our full ergonomic evaluation for employees with an injury, chronic discomfort, medical condition, or is seeking medical or allied health treatment. We aim to schedule the appointment to occur within 1-2 weeks of first contact with employee. We send out a symptom survey and consent form prior to the appointment, then review with the individual onsite. We employ an educational approach, make immediate adjustments as able and as appropriate to past or current reported discomfort, and provide a comprehensive handout. Within 10 days of the evaluation, we provide a comprehensive report including the employee concerns, intervention details, before and after photos, and additional recommendations. We also provide two brief remote follow-ups (at 2 weeks and 8 weeks), and circle back to you to close the case; and if there are lingering issues, we will follow up directly with the employee to try to resolve (up to 10 min. phone call) – all at no additional charge!

This form will accommodate 2 to 8 requests for employees at the same location.
 
Please enter your contact information here.
Please type the company name.
Please type your full name.
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Please enter the employees information below. All employees entered onto this form MUST be at the same location.
Please enter the facility name and address.
Please type the first employee's full name.
Please tell us if this employee's assessment should be in-person or via telephone.
Please tell us if this employee's assessment should be in-person or via telephone.
Please enter a 10 digit phone number. XXX-XXX-XXXX
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Please type the second employee's full name.
Please tell us if this employee's assessment should be in-person or via telephone.
Please tell us if this employee's assessment should be in-person or via telephone.
Please enter a 10 digit phone number. XXX-XXX-XXXX
Invalid email address. Please make sure there are NO spaces prior to or after your email entry.
Please type the first employee's full name.
Please tell us if this employee's assessment should be in-person or via telephone.
Please tell us if this employee's assessment should be in-person or via telephone.
Please enter a 10 digit phone number. XXX-XXX-XXXX
Invalid email address. Please make sure there are NO spaces prior to or after your email entry.
Please type the second employee's full name.
Invalid Input
Invalid Input
Please enter a 10 digit phone number. XXX-XXX-XXXX
Invalid email address. Please make sure there are NO spaces prior to or after your email entry.
Please let us know if you are human, by checking the 'I am not a robot' box.
If you have entered all requests please Submit. Otherwise please continue to the next page
Please enter the employees information below..
Please type the first employee's full name.
Invalid Input
Invalid Input
Please enter a 10 digit phone number. XXX-XXX-XXXX
Invalid email address. Please make sure there are NO spaces prior to or after your email entry.
Please type the first employee's full name.
Invalid Input
Invalid Input
Please enter a 10 digit phone number. XXX-XXX-XXXX
Invalid email address. Please make sure there are NO spaces prior to or after your email entry.
Please type the second employee's full name.
Invalid Input
Invalid Input
Please enter a 10 digit phone number. XXX-XXX-XXXX
Invalid email address. Please make sure there are NO spaces prior to or after your email entry.
Please type the second employee's full name.
Invalid Input
Invalid Input
Please enter a 10 digit phone number. XXX-XXX-XXXX
Invalid email address. Please make sure there are NO spaces prior to or after your email entry.