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ATTORNEY INFORMATION

COMMENTS/SPECIAL INSTRUCTIONS

REFERRAL SOURCE INFORMATION

Complete form or upload Form 19 and claim information sheet

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CLAIMANT INFORMATION

TREATING PHYSICIAN INFORMATION

EMPLOYER INFORMATION

Rehabilitation
Management
Inc.

Contact Us

Corporate Office


PO Box 3240

Monroe, NC 28111

​

Phone: 704.276.3311

Fax: 704.276-3316

 

 

Western Regional Office


PO Box 49

Vale, NC 28168

​

Phone: 704.276.3311

Fax: 704.276-3316

 

 

2025

 REHABILITATION MANAGEMENT, INC.

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