How To Order / Request An Exam
Fill out our ONLINE REFERRAL FORM. (see form below)
FAX PATIENT INFO (demographics) to (310) 356-7910.
Just give us a call at (800) 411-1006
We verify insurance, request authorization, and schedule the examination.
REQUEST AN EVALUATION
Please use the following form to request an evaluation. This form may be used for an Independent Medical Evaluation (IME), Qualified Medical Evaluation (QME) or an Agreed Medical Evaluation (AME), anywhere within the United States and Canada.