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