Update Your Medical Treatment Records

If you’ve recently had a visit with your regular doctor or another medical professional, please tell us about it!

Staying current & up-to-date on your medical treatment will help us provide better service to you and help us prepare your case.

Please use the form below to provide your update. If you have any questions or need help, feel free to calls us at 1-877-678-0935. Thanks!

HAVE AN UPDATE REGARDING YOUR MEDICAL TREATMENT?

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.

First Name(Required)

Last Name(Required)

If your current email is not shown here, please enter your email address.

Phone(Required)

If the best phone number to reach you is not shown, please enter it here

Address(Required)

Please type your full address here

Doctor's Name(Required)

Name of the treating medical professional

Doctor's Street Address(Required)

Address of the treating medical professional's office

Doctor's City(Required)

City/town of the treating medical professional's office

Doctor's Zip Code(Required)

Zip code of the treating medical professional's office

Doctor's Phone(Required)

Phone number for the treating medical professional's office

Date of Visit(Required)

Please enter the date of your visit with this medical professional

Reason for Visit(Required)