REFERRAL REQUESTS

Request a referral

Are you a claims adjuster looking to refer an injured worker to CompRehab? Contact us for a workers’ compensation statutory rehabilitation referral request by filling out the form below and we will get back to you shortly.

Name*
First Last
Address*
Street address Address line 2 City State ZIP
Phone*
Email*
Services requested (check all that apply)*
- Rehabilitation consultation (eligibility determination)
- Statutory vocational rehabilitation
- Medical case management
- Functional job analysis
- Recommendations for job modifications
- Ergonomic workstation evaluation
- Job coaching
Additional information (optional)
CAPTCHA
Phone
This field is for validation purposes and should be left unchanged.