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Pinnacle Orthopaedics Workers Comp Physicians Atlanta, GA
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QUICK CONTACTS

Workers' Compensation - Austell Division
Patrice Ledford, MPWCP
wc_austell@pinnacle-ortho.com
Phone: 678-945-8528
Fax: 770-745-3162

Workers' Compensation Coordinator - Marietta Division
Angela Wright
Angela.Wright@pinnacle-ortho.com
Phone: 770-429-6505
Fax: 770-514-6745

Workers' Compensation - Marietta Division
Elizabeth Rende, MPWCP
Elizabeth.Rende@pinnacle-ortho.com
Phone: 770-514-6749
Fax: 770-514-6745

Request an Appointment
Schedule an Independent Medical Examination
Schedule a Second Opinion
Schedule a Disability/Permanent Impairment Rating
Medical Records Request
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Appointment Request Form

Thank you for your interest in Pinnacle Orthopaedics. We are pleased to offer the following Workers' Compensation Appointment Request Form. Please note that every effort is made to get back to you within 24 hours of submitting this appointment request. Initial appointment authorization from your insurance company must be obtained prior to scheduling the appointment. If you wish to speak with the appointment desk directly, please call 770-427-5717 (Marietta Division) or 770-745-3162 (Austell Division).




Contact name if different than patient:

Phone:
Email:

Insurance Information
Insurance Company/TPA:

Address:

Adjustor Name:

Adjustor Phone:
 Adjustor Fax:

Nurse Case Manager:

Nurse Case Manager Phone:
 Nurse Case Manager Fax:
Claim Number:
 Date Of Injury:

Patient Information
Name:

Date of Birth:

Address:

City:
 State:
 Zip:

Phone:

Employer:

Address:

City:
 State:
 Zip:

Contact Person:

Phone:
 Fax:


Are you a new or existing patient?

Injured body part:

Appointment Request with Physician (Pending Availability):

Appointment First Choice (Pending Availability):


Appointment Second Choice (Pending Availability):



Please leave the following field blank:


  

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