independent medical evaluation

law firms & other organizations

Dr Riccardo Caniato is available for IMEs. For all IME requests, please complete the form below for Dr Caniato to review and we will respond within 72-hours.

Independent Medical Evaluation Request

Name of Company or Law Firm

Office Location

Name of Person Booking

First Name

Last Name

Telephone of Person Booking

Email of Person Booking

Name of Client (to be assessed)

First Name

Last Name

DOB / Age of Client

What is the nature of the matter?

Other (please specify the nature of the matter below):

Location for Appointment

Other (please specify your preferred location below):

Date of Appointment Requested

Other (MM/YYYY):

Preferred time of appointment (am / pm / any)

Additional Info

independent medical evaluation

law firms & other organizations

asking for help is always a big step.

For urgent mental health concerns

For life threatening emergencies