Thanks for letting us know!

We appreciate you taking a moment to confirm receipt of our message!

If you have any questions at all about your case please do feel free to call us at 1-877-678-0935. Our Claimant Services team would be happy to assist you.

But wait! Before you go….

If you’ve had a recent medical treatment or visit with a medical professional, tell us about it!

And if your contact information has changed (for instance, a new email address, phone number, home address, or preferred alternate contact) we’d love it if you could update your info!


If you’re an existing client and have updated information about your medical treatment, please let us know. If we have any questions for you, a member of the Client Services team will be in touch with you directly.
If your current email is not shown here, please enter your email address.
If the best phone number to reach you is not shown, please enter it here
Please type your full address here
Name of the treating medical professional
Address of the treating medical professional's office
City/town of the treating medical professional's office
Zip code of the treating medical professional's office
Phone number for the treating medical professional's office
Date of Visit(Required)
Please enter the date of your visit with this medical professional


If you’re an existing client and have changed phones, addresses, emails, or other important contact details, please let us know using this form. Client Services will be in touch to confirm your details directly. If the info you see here is not correct, please update it!
Date of Birth(Required)
If you have an email address, please make sure we have the correct / most current one!
Please enter the name & phone number of a trusted friend or family member who we can contact if we lose touch with you.