Booking Page - IME Watchdog Inc

Law Firm Information
Name*
First Last
Law Firm Name*
Email*
Phone
Address*
Street Address Address Line 2 City State ZIP Code
Notes
Client Information
Client Name*
First Last
Client Phone*
Client Language*
consent
The client will need transportation to be provided for an additional fee charged after the appointment.
IME Physician Information
IME Physician Name*
IME Physician Address*
Street Address Address Line 2 City State ZIP Code
IME Physician Specialty
Date*
MM slash DD slash YYYY
Time*

: Hours

Minutes

AM/PM
File
Max. file size: 512 MB.
For example, BP, IME notice
Client Appointment
Price:
Coupon
Total
$0.00
Credit Card*

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Consent*
I agree
I understand if an IME is cancelled after 5:00 p.m. the day before the scheduled appointment, the IME will still be billed.
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