Medical Cost Projection Order Form

1. Complete the MCP Order Form below.

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

3. We will send you payment instructions, a services agreement to be signed, and treating doctor recommendation forms to be filled out and send back.

4. Once payment is received and all forms are returned, we will proceed with the evaluation.

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

Medical Cost Projection Order Form

Legal Representation

(e.g. auto, work, slip & fall, etc.)
Where X-rays were taken
Where MRIs were taken
Where injections were given
Where surgery was performed
Where surgery was recommended

Fee Details

  • $2,500 –Includes up to 5 hours of work. This covers most injury specific/non-complicated cases. Additional hours are at a rate of $400 per hour.
  • $1,250 –Retainer fee due to start. The remainder is due within 30 days of the close of the case.  We do not reduce.
Maximum upload size: 256MB