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Toggle Navigation
Services
Independent Medical Evaluations (IME/Medical Experts)
Disability Evaluations
Fitness for Duty
Industrial Disability Retirement Evaluations
Longshore and Harbor IME
Motor Vehicle IME
Neurosurgeon Medical Experts
Neuropsychological Medical Experts
Orthopaedic Spine Surgeons
Psychiatry Medical Experts and IME Services
Psychological Medical Experts and IME Services
Qualified Medical Evaluations (QME)
Agreed Medical Evaluations (AME)
Subsequent Injuries Benefit Trust Fund (SIBTF)
Join Our Team
Find a Physician
Locations
About
Leadership
Contact
Request Evaluation
IME Evaluation Request Form
IME Evaluation Request Form
Brian Law
2024-02-01T04:01:02-08:00
Purpose of IME
*
Specialty Needed
Scheduling Party/Client
Scheduling Party/Client Phone
*
Scheduling Party/Client Email
*
Requestor’s Name
Requestor’s Phone
*
Case Name
*
Examinee
*
City of Examinee’s Residence
Date of Incident/Injury
Reason for Evaluation/Injuries Being Evaluated
*
Handeling Attorney (if applicable)
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