Water Damage Cleanup & Mitigation Service Request Form

Service Request Form

Is this an Emergency?*
If (Yes) a Work Authorization form will be automatically emailed to you. Please read and sign the form. As soon as we receive a signed Work Authorization form a team is dispatched.
Full Name*
Last Name, First Name
Email*
Phone*
Address*
Street Address Street Address City State ZIP Code

INSURANCE INFORMATION
If you have not submitted a claim yet or don't have some of this information you can leave it blank for now.
INSURANCE COMPANY
POLICY NUMBER
CLAIM NUMBER
DEDUCTIBLE AMOUNT

Tell us about the claim
cause of loss, types of building materials affected, size of the affected area, type of flooring, amount of furniture & contents etc...
Picture Upload
Drop files here or
Accepted file types: jpg, gif, png, pdf, jpeg, .
If you have any pictures of the affected areas please upload them here. It will help speed up the process.
CAPTCHA

Water damage cleanup

Thank you for trusting Flood Doctor with your water damage emergency, repairs and restoration.

Flood Doctor’s Rapid Response units respond to claims 24 hours a day, 7 days a week.

Customer Service: 1(877)497-0007

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