Referrals

Referral information may be faxed directly to PRC at 804-271-9149 or you may complete the form on the right with basic claim information if you prefer. We will contact you as soon as possible after the information is received to discuss the specific needs of your claim. Where possible, we are also available to copy file documentation at your place of business.

You can also send referrals directly to PRC via email to: referrals@prciva.com

Your Information:

Company:

Email:

Telephone:

Referral Type: Medical Vocational Medical File Review Life Care Planning Ergonomic Assessment

Injured Employee:

Employee Name:

Telephone:

Employee Address:

Comments:

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