Patient Enrollment Form

Enrolling with IWP is easy. Simply fill out the form below and our team will contact you today, so that you can begin receiving your workers' compensation or auto medications tomorrow.
Patient Information
Claim Information
If you have your claim information and would like to submit it now, please complete the section below, otherwise an IWP representative will contact you shortly.
If applicable

Insurance Carrier

Employer

Physician

Attorney

Referral Information
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