Send a Referral | Injury Network Chicago

Send a referral

Tell us who to call. A coordinator follows up by phone and schedules the visit with a licensed provider near the patient's home or work. There is no charge to the referring firm.

Your first name *

Your last name *

Firm or organization *

Your phone *

Your email *

I am a:

Patient name *

Patient phone *

Patient's preferred language

Case type

ZIP code where the patient lives or works (optional)

Message (optional)

Please do not include medical records, diagnoses, or treatment details.

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I consent to receive transactional messages related to my inquiry, appointments, or services I have requested from Meridian Care Solutions LLC dba Injury Network Chicago. These messages may include appointment reminders, confirmations, and account notifications among others. Message frequency may vary. Message & Data rates may apply. Reply HELP for help or STOP to opt out.I consent to receive marketing and promotional messages, including special offers, discounts, and new service updates, among others, from Meridian Care Solutions LLC dba Injury Network Chicago. Message frequency may vary. Message & Data rates may apply. Reply HELP for help or STOP to opt out.

A coordinator follows up by phone. No medical details are collected on this form.

Prefer to call? (312) 451-0101