Annapolis Chiropractors
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We welcome all referrals of workers' compensation patients from attorneys, physicians and claims administrators. You can send a PATIENT REFERRAL to us using the Online Quick Referral Form to the right. We also have a form (link below) you can fax or mail. Click here to open the printable Quick Referral Form. Simply print the form and fax or mail to our office.

Quick Referral Form
(Secure Online Form)

Patient Name
Home Address
Home Phone
Cell Phone
Work Phone
Email
Date of Birth
Date of Injury
Type of Symptoms
Referred By
Administrator
Lawyer
Other  
Workers Compensation Insurance Carrier
Claim #
Your Name  
Your Phone  
Kinesotape

The Center Annapolis, LLC
1610 West Street, Suite 201
Annapolis, Maryland 21401
Telephone 410-320-8484