Use our HIPAA compliant online Scheduling Request Form to get your case on the schedule faster.  For additional assistance or doctor information, contact our experienced Scheduling Team by email, or call us at 1-800-261-FAST (3278).

Note: Fields with an asterisk(*) are required.

Your Contact Information


Claimant Information

(by choosing "Yes" you MUST provide a mailing address in the above field.)

(by choosing "Yes" you MUST provide a phone number in the above field.)

Service Information

(If you are not sure which doctor to use please type "contact me" above. To request doctor listings or calendars, click here.)