What We Do
Workers’ Compensation
Case Management Solutions
Independent Medical Examinations
Short- & Long-Term Disability
Independent Medical Examinations
Occupational Health & Employer Solutions
Liability, Auto & No-Fault Insurance Solutions
Independent Medical Examinations
Government Solutions
Evaluations
Clinical Research
About
Leadership
Knowledge Center
Contact
Careers
Locations
Submit a Referral
What We Do
Workers’ Compensation
Case Management Solutions
Independent Medical Examinations
Short- & Long-Term Disability
Independent Medical Examinations
Occupational Health & Employer Solutions
Liability, Auto & No-Fault Insurance Solutions
Independent Medical Examinations
Government Solutions
Evaluations
Clinical Research
About
Leadership
Knowledge Center
Contact
Careers
Locations
Submit a Referral
IME Form
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First Name of Employee/Claimant
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Last Name of Employee/Claimant
Specialty
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Type of Referral
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IME
Case Management
Fit For Duty
FCE
File Review
Other
Line of Business
Disability
Workers' Compensation
Liability
No Fault
Employer Services
Referrer First Name
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Referrer Last Name
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Referrer Company
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Referrer's Title
Date