Legal / Attorney Referral

IME Referral Form

Dr. York provides independent orthopedic evaluations for workers' compensation, personal injury, and disability cases. Board-certified with 25+ years of surgical experience.

Reports typically delivered within 10–14 business days of examination. Rush available upon request.

Curriculum Vitae

Download Dr. York's full CV for records review and IME documentation.

↓ Download CV (PDF)

Referring Firm & Attorney

Information about the law firm submitting this referral

Law Firm Name *

Attorney Name *

State Bar Number

Phone *

Email *

Fax

Claimant Information

Information about the individual to be examined

Claimant Full Name *

Date of Birth

Claim / Case Number

Date of Injury

Injury Description

Examination Details

Type of Examination Requested

Specific Questions for the Examiner

Preferred Examination Date

Special Instructions / Additional Information

Fee Schedule

IME fees vary based on examination type and report complexity. A fee schedule and retainer agreement will be provided upon confirmation. Cancellations within 48 hours of the scheduled examination are subject to a cancellation fee.