Referrals

 

We accept referrals in a variety of ways including hard-copy print, email, fax or secure electronic upload. 

 

Electronic Forms

 

Referral Forms
Section 111
Queries and Reporting
Having trouble downloading our referral form? Click here
Documents Needed for Allocations

In order to prepare the most accurate Allocation possible, we will need these documents:

  • Most recent two years of medical records

  • First report of injury in workers' compensation cases

  • Claims payment history/listing

  • Pharmacy printout

  • Summary of medications (if available)

  • Completed referral form