Report a Change or Medical Update

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Please fill-out Change/Update Medical Form

No login required. Fast, secure, and direct.

Use this form to instantly notify our team of any updates to your medical care, contact information, or work status. You do not need to log into a portal—just fill out the fields below and hit submit. Our team will review this information and update your legal case file within 24 hours.

Name(Required)

First Last

Date of Birth(Required)

Required for identity verification

Best Phone Number(Required)

Required in case we have questions

Email(Required)

What has changed?(Required)

Please select the type of change you are reporting (You can select more than one)

New Medical Treatment or Doctor Visit

Changes to Medications

New Address, Phone, or Email

Work Attempts or Income Changes

New Medical Treatment

Doctor or Facility Name(Required)

Specialty/Type of Doctor(Required)

Approximate Date of Last Visit or Upcoming Appointment:(Required)

Reason for Visit / Any New Diagnoses or Tests Ordered(Required)

Medication Changes

What new medication(s) have you been prescribed? (Or list medications you have stopped taking)(Required)

Are you experiencing any severe side effects? (e.g., extreme drowsiness, nausea, dizziness)(Required)

Contact Information Updates

My New Physical Address is

Street Address City State / Province / Region ZIP / Postal Code Country

My New Phone Number is

My New Email Address is

Work or Income Updates

Have you attempted to return to work part-time or full-time?(Required)

Yes

If yes, what was your start date?(Required)

What are you earning per week? $(Required)

Note: Our legal team will review this to ensure your earnings remain compliant with strict Social Security guidelines

Additional Notes