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Appointment

Get direct nationwide access to our accredited and board certified physicians.

You are welcome to use our online scheduling form to request an appointment for an Independent Medical Evaluation or other services.

Upon receipt and review of your request, you will be contacted by one of our schedulers. An appointment request can also be called in toll-free at 877-642-4463.

Appointment Request Form

Appointment Form

First Name

Last Name

Company Name

Email Address

Address

Submit or Continue

Submit form as-is and receive a call from a scheduler

Continue Appointment Request Form

Service

IME

Re-Eval

Deposition

Med. Rec. Review

Other

Case Type

Work Comp.

Auto

Liab.

Disab.

Other

Please indicate if this case is litigated

Yes

Specialty Requested

Name of Preferred Physician

Jurisdiction

Time Frame Requested

Less than a week

1 - 2 weeks

2 - 3 weeks

Greater than 3 weeks

Claimant Information

First Name

Last Name

Address

Phone

Date of Birth

Date of Injury

Allegation

Claim #

Insured

Is Diagnostic Testing Pre-authorized?

Yes

Cite Letter Requested?

Yes

Translator?

Yes

Transportation?

Yes

Issues to be Addressed:

Diagnosis

Has past treatment been reasonable and necessary?

Does claimant require further treatment?

Can claimant RTW?

Restrictions

Maximum Medical Improvement (MMI)

Past or current need for attendant care / household svc / transportation svcs?

Additional Questions for the Physician

Additional Notes

File Upload

Select Files

Accepted file types: pdf, doc, docx, zip, jpg, jpeg, tiff, png, Max. file size: 128 MB, Max. files: 3.

I you need to submit more than 3 files or any files larger than 128 MB please compress your files and upload as .zip.

Founded in 1999, MEG delivers expert medical evaluations nationwide, backed by a trusted network and strengthened through its partnership with Medlogix.

IME Services

Scheduling
Case Management
Quality Control
Additional Services

Who We Serve

Attorneys
Adjusters
Insurance Carriers/TPAs

We Serve Nationwide

REQUEST AN APPOINTMENT

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The Medlogix Family of Companies includes Integrity, CHN PPO, MEG (IMEs), and ReviewWorks
providing a full range of medical claims management services for auto liability, workers' compensation, group health and IME services.