IMX - Medical Management Services

Request a Deposition or Testimony directly on-line! Simply fill out the form below and click Submit. Someone will respond to your request within one (1) business day. If you prefer to speak with us in person, don't hesitate to contact us.

This electronic IME Request Form utilizes state of the art security and data encryption. Advanced authentication technology is provided by the industry leader GeoTrust, an extension of Equifax. By activating the browser's "LOCK" icon, GeoTrust's Security Certificate employs 128-bit data encryption SSL (Secure Socket Layer) and assures online visitors that confidential information cannot be viewed, intercepted or altered in any way.


Patient / Claimant's Name:
Your Name:
Telephone:
E-mail Address:
	re-type email address:

Attorney Name:
Firm's Name:
	Defense, Plaintiff

Physician / Provider:
Time Frame for Service:	(mm/dd/yy - mm/dd/yy)

	Oral Deposition, Video Deposition, Live Testimony

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IMX Medical Management Services - Two Bala Plaza, Suite 600; Bala Cynwyd, PA 19004 Toll free: 800.707.0575, P: 610.667.4463, F: 610.667.4764 Copyright © 2003, IMX Medical Management Services, Inc. All rights reserved.