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DUOA Request Form

"*" indicates required fields

Today's Date

Deadline

SSN

Name

First Middle Last

Sex

M

F

Date of Birth

Address

Street Address Address Line 2 City State Zip

Client Name

Client First Name Client Last Name

Client Phone*

Client Email*

C.D.V. Request Form

"*" indicates required fields

Today's Date

SSN

Name

First Middle Last

Sex

M

F

Date of Birth

Address

Street Address Address Line 2 City State Zip

Phone*

Email*

AOE / COE Request Form

"*" indicates required fields

Step 1 of 6

Deadline

Today's Date

Deadline*

Number of Days

Restrictions

Special Instructions

Subject Information

Insured

Last Four of SSN#

Please enter a number from 0001 to 9999.

Subject Name

Sex

Date of Birth

Race

Height

Weight

Physical Description

Marital Status

Dependents

Vehicles

Address

Street Address Address Line 2 City State Zip

Phone

Cell

Claim Information

Claim Number

Injury

Claim Type

Workers Comp

Auto Accident

Liability

Insurance Company

Date of Loss

Prior / Current Physicians

Client Information

Total Budget

Your Name

First Last

Company

Address

Street Address Address Line 2 City State Zip

Phone*

Fax

Email*

Information Release

Attach Files

Max. file size: 20 MB.

Please attach the claimants' Release of Information, photos and any other files

Additional Services

If you choose to add any of the below services we can offer you a discount of $100 off each item added

Additional Services

Surveillance

Medical Check

Social Media Search

Background Check

Background Check Request Form

"*" indicates required fields

Step 1 of 6

Deadline

Today's Date

Deadline*

Number of Days

Restrictions

Special Instructions

Subject Information

Insured

Last Four of SSN#

Please enter a number from 0001 to 9999.

Subject Name

Sex

Date of Birth

Race

Height

Weight

Physical Description

Marital Status

Dependents

Vehicles

Address

Street Address Address Line 2 City State Zip

Phone

Cell

Claim Information

Claim Number

Injury

Claim Type

Workers Comp

Auto Accident

Liability

Insurance Company

Date of Loss

Prior / Current Physicians

Client Information

Total Budget

Your Name

First Last

Company

Address

Street Address Address Line 2 City State Zip

Phone*

Fax

Email*

Information Release

Attach Files

Max. file size: 20 MB.

Please attach the claimants' Release of Information, photos and any other files

Additional Services

If you choose to add any of the below services we can offer you a discount of $100 off each item added

Additional Services

Surveillance

Medical Check

Social Media Search

Social Media Request Form

"*" indicates required fields

Step 1 of 7

Deadline

Today's Date

Deadline*

Subject Information

Insured

Last Four of SSN#

Please enter a number from 0001 to 9999.

Subject Name

Sex

Date of Birth

Race

Height

Weight

Physical Description

Marital Status

Dependents

Vehicles

Address

Street Address Address Line 2 City State Zip

Phone

Cell

Claim Information

Claim Number

Injury

Claim Type

Workers Comp

Auto Accident

Liability

Insurance Company

Date of Loss

Prior / Current Physicians

Client Information

Total Budget

Your Name

First Last

Company

Address

Street Address Address Line 2 City State Zip

Phone*

Fax

Email*

Social Media & Internet Investigations

Are you looking for any specific information regarding the claimant’s activities that might contradict their claim, such as: are they currently working, are they participating in any physical activities, any history or documentation of prior injuries, etc.?

Any general claim information that can be passed along (i.e. are there any physical restrictions/limitations, loss of income, trauma, etc.)?

Are there any specific dates and/or timeframe you are more concerned about that you would like us to look more closely at?

General information that might help identify a claimant and confirm the ID for any information we find, such as: information re: spouse, children, relatives, employment, hobbies, telephone number(s), address(es), email address(es), etc.?

Any “internal info” that might have been passed along regarding the claimant that might contradict their claim (i.e. – claimant is an employee and a co-worker informed someone they might be engaged in an activity that contradicts their work restrictions)?

Updated Social Media Report in 60 Days

Yes

No

Information Release

Attach Files

Max. file size: 20 MB.

Please attach the claimants' Release of Information, photos and any other files

Additional Services

If you choose to add any of the below services we can offer you a discount of $100 off each item added

Additional Services

Surveillance

Medical Check

Background Check

Surveillance Request Form

"*" indicates required fields

Step 1 of 6

Deadline

Today's Date

Deadline*

Number of Days

Restrictions

Special Instructions

Subject Information

Insured

Last Four of SSN#

Please enter a number from 0001 to 9999.

Subject Name

Sex

Date of Birth

Race

Height

Weight

Physical Description

Marital Status

Dependents

Vehicles

Address

Street Address Address Line 2 City State Zip

Phone

Cell

Claim Information

Claim Number

Injury

Claim Type

Workers Comp

Auto Accident

Liability

Insurance Company

Date of Loss

Prior / Current Physicians

Client Information

Total Budget

Your Name

First Last

Company

Address

Street Address Address Line 2 City State Zip

Phone*

Fax

Email*

Information Release

Attach Files

Max. file size: 20 MB.

Please attach the claimants' Release of Information, photos and any other files

Additional Services

If you choose to add any of the below services we can offer you a discount of $100 off each item added

Additional Services

Medical Check

Social Media Search

Background Check

Surveillance

Medical Check

Social Media Search

Background Check

Contact GCS

Nationwide Investigative Services

Need help with an investigation? Call our dedicated professionals at (888) 365-3940