Predesignation of Personal Physician

Prior to sustaining an injury or illness related to your employment, you may be treated for such injury or illness by your personal medical doctor (M.D.), doctor of osteopathic medicine (D.O.) or medical group.   Please complete the attached form and return to the Workers' Compensation Office. 

Predesignation of Personal Physician -DWC Form 9783

Notice of Personal Chiropractor or Personal Acupuncturist -DWC Form 9783.1

777 North F Street, San Bernardino, CA 92410 | Phone: (909) 381-1100 | Fax:

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