Please fill out the form below by providing your information and someone from our Workers' Compensation Department will contact you to schedule your Independent Medical Evaluation.* ) indicates a required field
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Preferences
Preferred Physician:*
Please select one
Any/First Available
Anton J. Fakhouri, MD
Gary A. Kronen, MD
Beverlee A. Brisbin, MD
Sarkis M. Bedikian, DO
Adam F. Meisel, MD
Prasad Gourineni, MD, MD
Chris Chapman, DO
Svetlana Zats, DPM
Preferred Location:*
Please select one
Palos Hills, IL
Mokena, IL
Chicago, IL
Lombard, IL
Part of the body to be examined:*
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Hip
Femur
Knee
Leg
Shoulder
Hand/Wrist
Hip or Knee Replacement
Other (Please explain)
Please explain nature of the injury or illness:
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Thank you!
Thank you for submitting your request for an Independent Medical Evaluation online. Someone from our Workers' Compensation Department will contact you as soon as possible to schedule your evaluation.
