INTERTEL Partners with Duck Creek Technologies

Request Form

Medical Checks

(TWO BUSINESS DAYS - 48 HOURS)
20 facilities in a 70-mile radius of the address provided, with a fast 48 Hour turnaround time.
10 Hospitals | 10 Pharmacies

Request Records

Records Retrieval powered by Ontellus, the nation’s largest records retrieval partner, providing best-in-class technology with unparalleled data security for insurance and claims litigation.

Request any type of records, including but not limited to: Medical & Billing Records, Employment Records, Pharmacy Records, Phone Records, Workers’ Compensation Records, etc.

Social Canvassing


INTERTEL’s industry-leading Social Canvass is a comprehensive tool used to identify and secure a person's public social media profile.

Requestor Information

(Fields in red are required.)

Your Name:
 Title:
Company: 
 Email: 
Address: 
City: 
 State: 
 Zip: 
  
Phone: 
 Fax:
  
Insured/Client: 
 Claim#: 
  
Coverage Type:
 Other:
Billing P.O.C.:
Billing Phone:
  
Billing E-mail Address:

Claimant Information

(Fields in red are required.)

Claimant First Name: 
 Claimant Last Name: 
Alias:
  
SSN: 
 D.O.B.: 
Address: 
City: 
 State: 
 Zip: 
  
Email **Strongly Recommended for Social Canvassing, but not required:
Phone:
Employer:
Address:
City:
 State:
 Zip:
  
Phone:
 Contact:
Claimant's Position:
D.O.I.: 
 Last Worked:
Nature/Extent of Alleged Injury/Loss: 
Due Date:
 Referral #:
Additional Comments:

File upload:

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