Medical-legal evaluation request.

Name: North County Orthopedic Medical Group
Address: 8929 University Center Ln, Ste 100, San Diego, CA, 92122, US
Telephone: (858) 457-4040
Price range: $$

QME, AME, IME, deposition, trial testimony, record review, and supplemental reports.

Call (858) 457-4040 All forms

Requester

Requester type *

Firm / company *

Contact name *

Role / title

Phone *

Email *

Mailing address

Case

Claimant / patient name *

Claimant DOB

Claim number

WCAB / ADJ number

Date of injury

Body part(s) at issue *

Jurisdiction *

Services requested

QME evaluation

AME evaluation

IME evaluation

Record review & written opinion

Deposition

Trial testimony

Supplemental / re-eval report

Report specialty needed

Deadline / due date

Opposing counsel (if any)

Rush / expedited handling requested

Additional notes

Attach records / prior reports (optional)

For large record sets, submit the request and our office will send a secure upload link.

No client information is stored on your device. Transmission is over TLS to our intake system. For anything containing PHI beyond this intake, coordinate a secure share link with our medical-legal coordinator.

I agree to receive emails from North County Orthopedic Medical Group about my request (confirmations and follow-up).I agree to receive text messages from North County Orthopedic Medical Group about my request. Msg & data rates may apply. Reply STOP to opt out.

Se habla español · Workers' Comp & Longshore accepted · Most major insurance plans

Board-certified orthopedic surgery, workers' compensation care, and medical-legal evaluations in San Diego County.

Se habla español · Interpreter services available

Services

All Services
Work Injuries
Medical-Legal (QME/AME/IME)
Patient Forms
Attorney Referrals

Visit / Contact

8929 University Center Ln, Ste 100
San Diego, CA 92122
(858) 457-4040
Fax: (858) 457-4936
slevine@northcountyomg.com

Hours

Mon – Fri8:00 AM – 4:00 PM
Sat – SunClosed

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This site is for informational purposes and does not constitute medical advice.

Call (858) 457-4040