Request an IME

IME Request Form

Complete this form and we will contact you within 1 business day to confirm the information and to provide you with a date and time for the IME. Thank you for your business! Your information is confidential.

  • General Information

  • Requestor Information

  • Claimant Information

  • MM slash DD slash YYYY
  • Exam Information

  • Please provide any additional information regarding a specific orthopedic specialty or physician you may require.
  • This field is for validation purposes and should be left unchanged.