3 IME Referral Form

Referral For IME by Dr. Vallentyne

Please complete all entries then press the SUBMIT button.

Part I: Client Information
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Part II: Referrer Information
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Part III: Report Information
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Reports are classified with regard to (a) the urgency of the appointment and (b) the turnaround time between assessment and the completion of the report.

  • Standard Appointment: A Standard Report is scheduled as the next available appointment. The IME report is available within 8 weeks after the appointment. The standard appointment is billed at BCMA rates including consult ($387), document review $365/hr, medicolegal opinion $1532 (last updated May 2010). This report request may be cancelled up to 2 weeks prior to the appointment. Cancellation <2 weeks prior to the appointment results in a $100 late cancellation fee. If not otherwise specified, this is the default report type.
  • Expedited Report: An Expedited Report is scheduled as the next available appointment (ie, same as Standard Appointment). The IME report is available within 2 weeks after next available appointment billed as Standard Report plus $200 expedited fee. This report request may be cancelled up to 2 weeks prior to the appointment. Cancellation <2 weeks prior to the appointment results in a $200 late cancellation fee.
  • Urgent Evaluation: When a request for an Urgent Evaluation is confirmed, the assessment appointment is scheduled within 7 days of referral confirmation. The IME report is available within 48 hours after appointment. This appointment is billed at $8,000 inclusive of consult, document review, case discussion, and comprehensive medicolegal opinion. Please note that this report cannot be cancelled once confirmed by the referrer.