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Pinnacle Orthopaedics Workers Comp Physicians Atlanta, GA
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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

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Medical Records Request
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Workers' Compensation Medical Record Request

Patient Information
Name:

Date of Birth:

Claim #:

Identify the records being requested:

Where would you like the records sent:


Requestor Information:
Name:

Company Name:

Phone:

Fax:

Address:

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