Refusal to Seek Medical Treatment Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *I am a healthcare worker employed by Craft Health. My employer, Craft Health, has offered to provide me with information on receiving medical care in regards to the accident report I completed on (enter date of the incident below). *However, I, of my own free will and accord, and despite my employer’s offer, have elected to not receive medical treatment at this time. I am also aware that even though I am waiving medical treatment at this time, I can still seek medical treatment at a later date. I understand that by typing my name below and clicking on "Submit", I am electronically signing this document and am certifying that the above information is true and correct. A copy of this form will be emailed to you and HR. *Date * Submit