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For injured workers
Intake packet — download and complete
Once a file is referred, we send the injured worker this packet. It can also be downloaded here, printed and brought to the first appointment. The consent form is provided in English and Spanish.
Consent for Vocational Case ManagementEnglish and Spanish · Consentimiento para el manejo del aspecto vocacionalPDFAuthorization to Release Medical InformationValid one year from the date of signaturePDFInitial Vocational Evaluation QuestionnaireWork history, education, medical background and physical capabilitiesWordI-9 Employment Eligibility VerificationFederal form — confirm the current revision at uscis.gov/i-9PDF
Completed forms can be brought to your appointment, faxed to 855-837-2681, or emailed to vocationalrehabservices@gmail.com. If you need help completing them, call or text 702-857-9460 — our staff can assist in English or Spanish.
What to bring to the first appointment
- A list of every job you have held, with dates and what you actually did
- Certificates, licenses or training, including from outside the United States
- Your physician's most recent report describing your restrictions
- Pay information, if you have it
- Photo identification
If Spanish is the language you think in, say so when you schedule. Every counselor here works in English and Spanish, so you will not be interviewed through an interpreter.
Questions about the packet?
Call or text and ask for the counselor on your file. English and Spanish.