Impairment Rating Intake Form

This form is for patients who need to complete an intake form for an Impairment Rating by Federal Injury Group.

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Please complete the form below to submit your Impairment Rating intake information. This is required as you are being asked to complete an Independent Medical or Impairment Exam (IME). If you have any questions while filling out this form, please call 727-600-8024 or 866-981-4581.