Welcome To Work & Well’s Employee Home Page

On this page, you will find information that will help you during your leave. What would you like to do?

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Forms And Information To Download

About Work & Well
Request for Medical Leave (MD form)
Department of Labor FMLA form
Authorization to Release Medical Information
Return to Work note
Directions for reporting intermittent FMLA time
Paternity Application form
State of New Jersey Disability form
State of New York Disability form
State of California Disability form
Accident Report for Workers' Compensation Claim

If you download an application packet, you must call Work & Well at 800.464.6082 to activate your case. The application packet must be completed and received by Work & Well, Inc. within 15 days. Contact Work & Well for the exact date your paperwork is due.

If you have call intercept or privacy block, it is your responsibility to notify Work & Well and make arrangements for us to contact you during your leave.

If you have any questions about these forms or your leave, call Work & Well at 800.464.6082. Our business hours are Monday through Friday, 8:30 a.m. - 5:00 p.m. EST.

Send or fax your completed forms to:
Work & Well, Inc.
92 East Main St.
Suite 203
Somerville, NJ 08876
908.429.5535 FAX