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The Co-operators Forms

Humania Forms

Fenchurch Forms

Supplemental Medical Information Request – Appeal

Direct Deposit Authorization

Claimant Statement

Authorization for Release of Information

Attending Physician Statement

Authorization for Release of Information (Employer)

Direct Deposit Authorization (Employer)

Attending Physician Statement (Employer)

Claimant Statement (Employer)

Employer Statement

Early Intervention Form

Other Forms