Claim Intake Form
NOTE: Forms submitted on this website are reviewed during regular business hours. Although we try to respond as quickly as possible, we ask that you please allow up to 2 business days for a response.
Submission of this form is not a guarantee of payment or settlement for any claims.
Submission of this form is not considered a formal claim to your insurance carrier. We will review the contents of the data you submit and discuss (with you) how best to proceed with your claim.
Any information submitted through this form or the Aegis website is used for our own internal purposes and is never sold or given to anyone outside of our organization.