Contact Us Name * First Name Last Name Address Address 1 Address 2 City State/Province Zip/Postal Code Country Home Phone #: (###) ### #### Date of Birth MM DD YYYY Insurance Policy Name and ID: Email me WC or Personal Injury Yes No Pain Complaint Low Back Pain Neck Pain Knee Pain Shoulder Pain Other Thank you for contacting us. An Innovative Pain Care representative will be responding to your submission shortly. Innovative Pain Care3111 W Rawson AveFranklin, WI 53132Telephone: 414.260.5544Fax: 866.471.2829