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Communicating + Identifying = Resolution

Your feedback continues to help OM identify, prevent and remove non-compliant providers from our provider list. Our goal is to ensure your workers' comp requests are handled promptly, professionally, and efficiently. Your feedback is very important to us so that we can keep providing you with the most qualified providers for your injured workers.


The Good, The Bad, and The Ugly, we want to hear it!

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 in the providers and their staff that need improvement. 

Should you require immediate assistance, work notes, work statuses, follow-up appointments, or if you need assistance with DWC-25, etc., or prefer to respond by telephone, please feel free to contact us at1-866-640-4060


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

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You may choose to skip any question that does not pertain directly to your feedback.

Do You Refer To The Physician and/or Practice?
Are You Receiving Paperwork In A Timely Manner?
Overall Rating of Physician/Practice
PoorFairGoodVery goodExcellent
Is The DWC25 Completed Properly?
Are the physician following protocols when writing a prescription for radiology, therapy, DME, orthotics, other services, etc.?
Does the provider understand the employers hold the responsibility of making accommodations for Injured Employees who are determined to have work restrictions based on the Physician’s documentation on the DWC-25?
Are the physician notes written at each appointment consistent with the information contained in each DWC-25?
Are authorized services being over utilized?
Are You Having Any Communication Issues With The Physician, Or With The Office Staff?

Please add your contact information so we can contact you to address any issues regarding the Physician and/or Practice. 

Thanks for submitting!

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