FEEDBACK FORM

We encourage you to take a few moments to give us your feedback, whether good or bad. Feedback is critical to us as it helps us identify areas the providers and their staff need improvement. 

Should you require any immediate assistance, work notes, work statuses, follow-up appointments, or if you need assistance with DWC-25, etc. or work prefer to respond by telephone; please feel free to contact us at

1-866-640-4060. 

Other methods of feedback:
Confidential compliance hotline is always available at

1-866-640-4060

Please add any questions, comments, concerns, and/or suggestions you may wish to share with us.

During each visit are the physicians completing the DWC-25 properly? Including:

• diagnosis

• treatment plan

• noting and identifying specific restrictions, if any, and why the Injured Employee cannot return to work full duty

• the causal relationship to the injury the date and time of the next appointment, if applicable

• The Physician gives a completed copy of the DWC-25 to the Injured Employee

The following are NOT acceptable under any circumstance regarding restrictions on the DWC-25 form:

• “Work as tolerated” 

• “Same as before”

• “No Change” 

The goal is to provide prompt, timely, efficient and superior medical care to each Injured Employee and assist each Injured Employee during injury recovery: ​

If you would like us to contact you, please fill out your contact information below (you may leave it blank to stay anonymous): ​

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