Referrals

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

Electronic Forms

Downloadable 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 need the following 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