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 Form2

Service Details

Were X-rays Taken?
Where X-rays were taken
Were MRIs Taken?
Where MRIs were taken
Were Injections Given?
Were injections given?
Was Surgery Performed?
Was surgery performed?
Was Surgery Recommended
Was surgery recommended?

Invoicing Details

In San Antonio, TX
$2,500 for the first five hours of work. This covers most injury specific, non-complicated cases. Additional hours are at a rate of $400 per hour.

$1,250 is required as a retainer/down payment, to start the process. The retainer payment, a signed services agreement, all required records, and provider recommendation forms are required before we start our research. The remainder is due within 30 days of the close of the case. We do NOT reduce our bill, win or lose.

Turnaround Time:
Turn around time is typically four weeks, once we have the retainer fee and required records to start. Expedited rates are available and determined on a case-by-case basis.

Maximum file size: 256MB