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Case Managers

We’re fully aware of the time constraints that case managers face in order to cover many medical visits in the same day. Therefore, we have arranged for an express pathway to our case managers and their patients.

If you are a case manager and looking to secure an appointment please complete the online form below or call Dr. Tannoury's office. We will be in contact with you within 24 hours.

Case Manager Information
Case Manager First*	Case Manager Last*
Case Manager Email*

Occupational Health Provider	Insurance Name

Please provide any information regarding your referring healthcare provider
Healthcare Provider Name
Healthcare Provider Email	Healthcare Provider Phone Number

If the referring provider has any patient background documentation to share, please upload here. If you have multiple files to share, you will need to attach them using a single zip file. File Size: 5000KB Maximum

Please provide any information regarding your patient
First Name	Last Name
Phone Number
Email

Date of Injury (MM/DD/YY)	Date of Desired Visit

Purpose of Visit* First ConsultationSecond OpinionFollow Up VisitRequesting Information

Worker's Compensation YesNo

In your own words, what you would like to achieve from this visit?

If you have any patient medical documentation to share, including x-rays, MRIs and CT scans, please upload them here. If you have multiple files to share, you will need to attach them using a single zip file. File Size: 5000KB Maximum

Employer Information
Company Name
Company Address 1	Company Address 2
City
State
Zipcode
Any additional employer contact information

Submit
* Required

Case Managers

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