Services (List) | Workers Comp McAllen

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Refer a Patient for Evaluation

Please fill out the form below with the necessary patient and contact information. Once submitted, our team will reach out to discuss available examinations and provide pricing details tailored to your needs.

Patient's First Name

Patient's Last Name

Patient's Date of Birth

Adjuster Email Address

Adjuster Phone Number

Injured Body Parts WITH Diagnosis Codes

Referring Physician

Referring Physician Email

Referring Physician Phone

Insurance Name *Clairfy if the claim is "Non-Network" or "Network"*

Referral Type

Maximum Medical Improvement / Impairment Rating

Department of Labor Maximum Medical Improvement

5th Edition Report

6th Edition Report

Post DD Alternate Maximum Medical Improvement/ Impairment Rating (Disputing) If checked off, click item(s) being disputed below:

MMI/IR

MMI Date

IR Percentage

Extent of Injury

Other

Upload File

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Thanks for submitting!

We will reach out to you within 1-2 business days!

For confirmation of reciept, feel free to contact us at 956-631-6918!

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