Injury Institute

Apply to Join Our Network

Become a trusted partner in our esteemed medical network. Reach out to a wider audience, collaborate with the best, and offer unmatched care.

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Join Our Network

Take Your Practice to New Heights

If you're a clinic or a private doctor looking to grow, we're here to support you. Fill out the form below and let's embark on a journey of collaboration, growth, and unmatched patient care.

Information of the person filling in the form

Please fill in all fields before submitting the form.

Information of the clinic or private doctor interested in joining

Please fill in all required fields before submitting the form.

General Practice
Medical professionals in surgical environment

Our Southern and Northern CA doctors offer a very effective approach assuring the very best in medical care with personal, prompt attention.

Connect with a provider

The clinic will communicate with you shortly on the days and times they have available to schedule an appointment.

Patient Contact Information
Enter the patient's full name (the person who is injured), for example: John Doe
Enter the patient's email address (the person who is injured)
Enter the patient's 10-digit phone number (the person who is injured) in the format: area code, 3 digits, 4 digits. For example: 8 6 6, 9 9 9, 5 5 5 5
Enter the patient's city of residence, for example: Santa Clarita
Enter the patient's state, for example: CA or California
Enter the patient's 5-digit zip code, for example: 91351
Enter the patient's date of birth
Enter the date when the patient was injured
General Practice
Legal Representative Contact Information
Enter your full name as the legal representative
Enter your email address as the legal representative
Enter your 10-digit phone number as the legal representative in the format: area code, 3 digits, 4 digits. For example: 8 6 6, 9 9 9, 5 5 5 5
Optional: Write any additional message or questions you have