CONNECTICUT'S
MOST TRUSTED
NAME IN
ORTHOPAEDICS &
SPORTS MEDICINE

Glastonbury Office
Call (860)633-1980

Manchester Office
Call (860)647-1493

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Is this a work related injury? * Yes No
 
If yes, please list the information below:
 
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Is your injury related to an automobile accident? Yes No
 
If yes, do you have med pay through your automobile insurance coverage?    Yes No
 
Note:
If you DO NOT have med pay, please have your car insurance provider fax us a note stating you do not have med pay. Our fax number is (860) 643-6709.
 
If you DO have med pay, please have your car insurance provider fax us a note stating your amount of med pay coverage. Our fax number is (860) 643-6709.
 
Regarding automobile accident related injuries: If your injury is related to an automobile accident, Advanced Orthopedics is legally required to go through your automobile insurance plan before your health plan will disburse any benefits.
 
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Call Us Today: (860) 647-1493

Manchester Office
155 Main Street, 2nd. Floor
Manchester, CT 06042
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