SECURELY UPLOAD DOCUMENTS
NAME
COMPANY
EMAIL
PHONE (optional)
TYPE OF REFERRAL REQUESTED:
ADDITIONAL SERVICES Medical Cost ProjectionsLife Care Plan ReviewLegal Nurse ReviewOTHER
COMMENTS (optional)
To officially submit referral, please make sure you downloaded the CMS referral form. Once you submit the above request, you will be redirected so you can securely upload additional documentation to include completed CMS Referral Form, First Report of Injury, medical records, or any other information. Please check this box to confirm that you have read this message.
Case Management Solutions 1110 Satellite Blvd. NW Suite 306 Suwanee , Georgia 30024
Monday-Friday: 7am – 7pm EST 24 Hour & After Hours Available
Corporate Office: 800.442.2230 770.840.1164
Info@CaseMgtSol.com
Referrals: Referrals@CaseMgtSol.com