Total Injury Care Appointment Request Form

Request an Appointment

Please complete the form below and a member of the Total Injury Care scheduling team will contact you as soon as possible to confirm your appointment details.
Full Name*

First NameLast Name
Contact Number*
Please enter a valid phone number.
Email Address*
example@example.com
Please briefly describe why you are requesting an appointment*
What was the date of the accident that caused your injury?*

MonthDayYear
Date
Are you currently working with an attorney?*

YesNo
Questions?

Please contact our offices by calling a TIC location near you - Phoenix: 602.610.7635 | Tucson: 520.230.8232
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Request an Appointment