IME / File Review Service Request Form

To place a request online, please complete the web submission form below. If you prefer a printable document, you may click “Download Form” – this form is an editable Word document that can be saved & emailed (or printed & faxed) to us at, or fax: 866-270-0082.

Should you have any questions regarding your request, or if your request requires URGENT or special attention, please call us at (845) 336-0549.