Marquez v. Midwest Division MMC, LLC

Submit Claim Form


Please enter your CPT ID and Passcode below to access your Opt-In Form. Your CPT ID and Passcode can be found in the Notice and Opt-In Form that was sent to you. If you do not have a CPT ID and/or Passcode, please contact us toll-free by calling 1-888-318-0103 or sending an email to