Thank you for responding to our online questionnaire form. Your response has been received and you may discard your paper questionnaire. Should you receive another questionnaire in the mail for the same injury, please disregard it as it was already in the process of being generated.  Please note that your assigned specialist may contact you if additional information is needed.

Should you have any questions or need to change your response, please feel free to contact our Customer Call Center at 1-888-468-4742 eastern standard time, Monday-Friday from 8:00 a.m. to 5:30 p.m.