Water Damage Cleanup & Mitigation Service Request Form

Service Request Form

Is this an Emergency?*
1 Hour Rapid Response to all emergencies.
YOUR INFORMATION
Full Name*
First Name, Last Name
Phone*
Email*
Address*
Street Address Address Line 2 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
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.
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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