Secure Online Referral

Please feel free to use this secure page to send referral information and files to us. We will confirm receipt so that you can be sure that the files and data came through. If you do not hear from us, please feel free to give a call for confirmation at (877) 905-7322 or email us at You may also fax us at 877-443-9344.

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Case Information



Referring Party


Required Documents We will need either a Medicare Set-Aside, CMS letter or Allocation report. If you have other relevant documents (Annuity, Settlement docs etc.) feel free to include those as well. You may also email documents to us at or fax at 877-443-9344.

Note Select multiple files by holding CTRL (CMD on Apple) and clicking file names. Only PDF, Word(.doc, .docx), Excel(.xls,.xlsx), Powerpoint(.ppt, .pptx), or image files (.tiff, .tif, .jpg, .jpeg, .gif, .png) are allowed. Maximum file size is 200MB, for files larger than this please contact us.

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