How To Order
We know you’re busy. We want to make working with us as easy and convenient as possible. We also know that every case and every claimant is unique. That’s why each report is built to your specifications. You call the shots when it comes to whom and where we canvass.

Ready to get started?
CLICK HERE to open the
new assignment referral.

Or, to submit a referral by
email or fax, please use
the below form. Once
completed, either email it to customerservice@hospitalcanvass.com
or fax it to (888) 328-4419.

Assignment Sheet

If you’d like to discuss your case,
we are also available via phone
at (800) 783-7718.

To initiate a canvass, we need the following information:

Subject Name



Subject Birth Date



Subject Social Security Number



Claim Number

· Target Search Area
– The most often used is the claimant’s current address but also used on occasion are previous addresses, work or jobsite addresses, vacation areas, or the address of a family member.

· Authorization
– Decide which canvass size suits your budget and your case. We have preset bundles of 15, 25, and 35 facilities, and the authorization is divided between the geographic locations and/or types of facilities you select. Additional locations can be added to any preset number of canvasses by typing in the number of additional locations you would like.

· Types of Facilities
- This is limited only by your imagination. Just point us in the right direction. See our Services page for a listing of commonly requested facilities and the reason they may benefit your claim.

 

In addition, some other
information is also useful:


· DATE OF ALLEGED INJURY/LOSS



· TYPE OF INJURY



· ALIASES

Other Useful Information

· If you have the name of a doctor that may have
possibly provided treatment, let us know and we
will locate that doctor and verify treatment.

· Already know about a hospital or doctor that’s
treated the claimant? Provide that information
and we’ll be sure to exclude it.

· Attach a recently signed Medical Authorization,
if one is available. Many facilities will not accept
a Medical Authorization if it has not been signed
within the last 60-90 days, but please send us
whatever you may have on file.

· If you have already completed a background
check or database research, feel welcome to
attach that to your assignment as well.

 


This website and our services are intended for the use of those in the insurance industry, including self-insured entities, third party administrators and licensed private investigators. We do not provide our services to the general public.