Referrals

To enquire about a referral, please contact Ellie Lapowich via email at elapowich@innovativecasemanagement.com or by phone at 905-882-5388.

Please fill out the following form:





Client Name (required):   Client Date of Birth (required):
      Client Date of Loss:
         
Client Address:   Client Suite/Unit:
Client City:   Client Postal Code:
Client Telephone 1:   Client Telephone 2:
         
Client List of Injuries:
         
Client Claim #:   Client Policy #:
Client Insurance Company:      
         
Lawyer:      
Lawyer Address:   Lawyer Suite/Unit:
Lawyer City:   Lawyer Postal Code:
Lawyer Telephone Number:   Lawyer Fax Number:
Lawyer File Number:      
         
Adjuster:        
Adjuster Address:   Adjuster Suite/Unit:
Adjuster City:   Adjuster Postal Code:
Adjuster Telephone Number:   Adjuster Fax Number:
         
         
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