Service Request | Discovery Pro

01

Service Details

Choose the service, document and delivery options that apply.

Service Requested *

Other Service Optional

X-Ray Copies Requested Optional

Document Sets Required Optional

Document Format

CD-ROM

FTP

Hard Copy

Send Copies To

Requestor

Defense Attorney

Applicant Attorney

Other Name

Bill To

Requestor

Defense Attorney

Other Name

Order Type *

Order Date

Due Date

02

Requestor Information

Provide the primary contact and firm details.

Firm/Company Name *

First Name *

Last Name *

Street Address

City

State

ZIP Code

Phone Number *

Fax Number

Claim Number / ADJ #

Email *

Employer

03

Case Documents & Instructions

Identify available documents and provide matter-specific instructions.

Documents Available

Signed Authorization/Release

Claimant Information

Provide the claimant and incident details available to you.

First Name

Last Name

Street Address

City

State

ZIP Code

Alias (A.K.A.)

Date of Injury/Accident

SSN

Provide only when required for the request.

Date of Birth

05

Attorney Information

Provide defense and applicant attorney details.

Defense Attorney

Same as Requestor

Law Firm/Lawyer

Street Address

City

State

ZIP

Email

Phone Number

Applicant Attorney

Same as Requestor

Law Firm/Lawyer

Street Address

City

State

ZIP

Email

Phone Number

06

Other Recipient or Billing Contact

Complete this section when “Other Name” is selected.

First Name

Last Name

Street Address

City

State

ZIP Code

07

Record Locations

Add up to 14 record locations, matching the original request form.

Record Location 1

Name

Record Type

Street Address

City

State

ZIP Code

Submit a Service Request

Tell us what you need.

Service Details

Requestor Information

Case Documents & Instructions

Claimant Information

Attorney Information

Defense Attorney

Applicant Attorney

Other Recipient or Billing Contact

Record Locations

Record Location 1

Record Location

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