Motor Vehicle Accident & Workers' Compensation Medlytix®

Your Name(Required)

Your Role(Required)

IMPORTANT

Attorneys (and law firm employees) should use ChartSwap or send a fax to +1 (678) 278-2578.

Patient Name

Company Name

Email(Required)

Phone number(Required)

By providing my phone number to Medlytix, I agree and acknowledge that Medlytix may send text messages to my wireless phone number for any purpose. Message and data rates may apply. Message frequency will vary, and you will be able to Opt-out by replying “STOP”. For more information on how your data will be handled please visit the Privacy Policy.

Reason for this inquiry

Please provide a description of your need and provide any information you think will help us assist you

CAPTCHA

MVA / WC Case Inquiry

Fill out the form below and our team will be in touch

This form should only be used to submit a Motor Vehicle Accident or Workers’ Compensation Case Inquiries

IMPORTANT