Frequently Asked Questions
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Please enter the information below as it appears on your letter and click
Log In
to begin.
Complete each section of the questionnaire as it applies to your injury/illness.
*
Web Code from Letter
Please enter the web code as it appears on your letter.
*
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 contact us at 800-598-2488.
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Indicates a required field.
