Welcome to The Rawlings Group online questionnaire!

Request for Medical Claim Information

To begin the online questionnaire, please enter the following information listed on the front of the letter you recently received.


* Required fields are indicated by an orange asterisk

The Web Questionnaire is not directed toward persons under 18 years of age. We do not knowingly market to or collect any personal information from children under the age of 18 through the internet. If you are under 18, you are not permitted to submit any personal information to us through this site. If you provide information to us through the Web Questionnaire, you represent that you are 18 years of age or older.