Set Aside Specialists, LLC

Specializing in Medicare Set-Aside Allocations

To refer a file, please feel free to enter the information in the following secure form and we will call you to discuss the file upon receipt.  If you prefer, you may call us at (704) 876-3232 or you may download a referral form (scroll to bottom of page) and fax it to us at FAX: (704) 876-3202.

We look forward to working with you.


 
Contact First Name
Contact Last Name
Position
Company Name
Address Line 1
Address Line 2
City
State
Zip Code
Daytime Phone() -
Fax() -
E-mail Address
Accepted Body Parts
Denied Body Parts
Claimant Last Name
Claimant First Name
Claimant Address
Claimant City
Claimant State
Claimant Zip Code
Claimant Date of Birth:
Claimant Social Security #:
Claim #
State of Jurisdiction
Employer
Employer Address
Employer City
Employer State
Employer Zip Code
Claimant Attorney
Claimant Attorney Firm Name
Claimant Attorney Address
Claimant Attorney City
Claimant Attorney State
Claimant Attorney Zip Code
Claimant Attorney Phone() -
Defense Attorney Name
Defense Attorney Firm Name
Defense Attorney Address
Defense Attorney City
Defense Attorney State
Defense Attorney Zip Code
Defense Attorney Phone() -
Comments
 
 
If you prefer to download a referral form and fax it to us, please click on the icon below.
 

 


 
If you wish to contact us by e-mail, fax, phone or letter please contact us at:

Set Aside Specialists, LLC
PO Box 523
Statesville, NC,US,28687
Phone: (704) 876-3232
Email:
Info@saspecial.com