We are looking forward to working with you. Please read and fill out the following documents below. You may submit digitally and we will print and mail.
Any forms not submitted digitally should be mailed to our offices at 303 Washington Avenue SW, Roanoke, VA 24016. If you need any assistance, please call our offices at 540.985.0098.
- Click here to fill out the HITECH Request Form. You will be directed to a new Docusign window. If you prefer to print, fill out, and mail the agreement, please download a copy here.
- Click here to fill out the Injury Client 1 Form. You will be directed to a new Docusign window. If you prefer to print, fill out, and mail the agreement, please download a copy here.
- Click here to fill out the Medical Authorization. You will be directed to a new Docusign window. If you prefer to print, fill out, and mail the agreement, please download a copy here.
- Click here to fill out the Social Media Agreement. You will be directed to a new Docusign window. If you prefer to print, fill out, and mail the agreement, please download a copy here.
- Click here to fill out the Hitech Bills Form. You will be directed to a new Docusign window. If you prefer to print, fill out, and mail the agreement, please download a copy here.
Contact Us
Office Address
Frith & Ellerman Law Firm, P.C.
303 Washington Avenue, SW
Roanoke, Virginia 24016
Telephone: (540) 985-0098
Fax: (540) 985-9198
Mailing Address
Frith & Ellerman Law Firm, P.C.
P.O. Box 8248
Roanoke, Virginia 24014