Healthcare Provider

Abstract

How to Complete This Form Step 1: Please complete the first section of this form and submit to your healthcare provider for completion of the second section. Step 2: Either you or your healthcare provider must return the completed and signed form to GW Benefits via email at benefits@gwu.edu or fax at (571) 553-8385 prior to your return to work. If a return to work authorization is not received in a timely fashion, your return to work may be delayed.