Contact Us Referral source Email Examinee/claimant name Male or female Male Female Date of birth Date of injury Describe injury: how old is it? Describe injury: which body parts are involved? Claim number Have you obtained records? Estimated # of records If WC company, does the referral source have an attorney assigned to the case? Does the patient have attorney representation? Can we call the patient before the appointment? Describe the purpose for requesting this IME? Any additional information Send Business Address 2415 Dearborn AvenueMissoula, MT 59801 Mailing Address P.O. Box 910Missoula, MT 59806 Montana Phone Montana Telephone: (406) 926-6950 Idaho Phone Idaho Telephone: (208) 775-7124 Fax Our Fax Number: (406) 926-6951