Impairment Rating Order Form

1. Complete the IR Order Form below.

2. Attach all imaging reports, treating doctor records, operative reports, surgical recommendations.

3. Send payment or attach an LOP.

* indicates a required field

Please give us a call if you have any questions – 833-222-5293

Impairment Rating Order Form

Legal Representation

(e.g. auto, work, slip & fall, etc.)
Where X-rays were taken
Where MRIs were taken
Were Injections Given?
Was surgery performed?
Was surgery recommended?

Service Details

We secure venue, if needed

In San Antonio, TX

  • $1,250

Travel Outside of San Antonio, TX

  • $1,750

Expedited (contact us if this is required)

  • $2,750

Maximum file size: 256MB

          Payment is due at time of service or you may send a letter of protection. Please send this form along with any reports mentioned above. We do not reduce our fee.