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WorkLink Appointment Request

Workers’ Compensation (WORKlink)

Tennessee Orthopaedic Alliance specializes in working with patients with Workers’ Compensation injuries. Use the online forms below to request information and appointments for workers’ compensation claims.

Step 1 of 6 - Patient Information

16%

Patient Information
Name*
First Last
Phone Number*
Work or Cell Number
Email

Employer and Request Information
Employer Name
Your role in this request?*
- Nurse Case Manager
- Adjuster
- Patient
What kind of appointment are you requesting?
- Appointment (response within 24 hours)
- Second Opinion (must send reports)
- IME Request
For which of the following are you seeking treatment?*
- Hip
- Knee
- Spine
- Shoulder & Elbow
- Foot & Ankle
- Hand & Wrist

Location Preference
What is your preferred appointment location?*
- Fort Sanders Regional
- The Tower at Parkwest
- Oak Ridge Physicians Plaza
- Lenoir City
- TOC Spine

Primary Insurance Information
Name of your insurance company?*
ID or Subscriber Number
Your insurance policy, plan or group number
Address
Street Address Address Line 2 City State ZIP Code

Claim Information
When did this injury occur?
MM slash DD slash YYYY
Claim Number
Contact Name*
First Last
Contact Phone Number*
Authorized Treatment of (Body Part)*

Additional Information
Would you like to join our mailing list?
- Yes, signup to receive regular updates from Tennesse Orthopaedic Clinics
Referrer?
If you were referred to us by another party, please enter their name here.
Comments
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We have convenient locations to serve our patients in East Tennessee

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Our Locations

TOA at Fort Sanders Regional
TOA at The Tower At Parkwest
TOA at Oak Ridge Physicians Plaza
TOA at Oak Ridge Orthopedic Urgent Care
TOA at Lenoir City
TOA at Sevierville
TOA at Bearden
TOA in Middle Tennessee

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