Frequently Asked Questions
Please enter the information below as it appears on your letter and click
Complete each section of the questionnaire as it applies to your injury/illness.
Web Code from Letter
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Event # from Letter
Please enter the event number as it appears on your letter.
Patient Last Name from Letter
Please enter the patient's last name as it appears in your letter.
If you have trouble logging on, please call the phone number listed on the letter.
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