GARLAND & ASSOCIATES
California Workers' Compensation
Medical Evaluations and Treatment
INDEPENDENT MEDICAL EXAMINATIONS
Schedule an Evaluation
Please fill out the following form and we will contact you as soon as possible (Usually within 1 hour or less)
If you have any questions, please give us a call at 888 455-1600 or click here to send us an email
Examiner / Attorney / Assistant email
Examiner / Attorney / Assistant Phone #
Type of Evaluation AME QME IME Eval & Treat QME Permanent & Stationary
Decision Date ( if any)
Please select the Doctor from the following for Podiatry
None Pete Thomas, D.P.M. Podiatry ( Downey Office ) Pete Thomas, D.P.M. Podiatry ( Santa Ana Office ) Pete Thomas, D.P.M. Podiatry (Perris - Inland Empire Office )
Please select the Doctor from the following for Orthopedic
None Any available orthopedic doctor with Garland & Associates before the decision date David Payne, MD Spine Surgery - General Orthopedic Surgery (Los Angeles office) David Payne, MD Spine Surgery - General Orthopedic Surgery (Long Beach office) David Payne, MD Spine Surgery - General Orthopedic Surgery (Riverside office) David Payne, MD Spine Surgery - General Orthopedic Surgery (Newport Beach office) David Payne, MD Spine Surgery - General Orthopedic Surgery (San Bernardino office) David Payne, MD Spine Surgery - General Orthopedic Surgery (Pomona office) Hose Kim, M.D. General Ortho, (Whittier office) Hose Kim, M.D. General Ortho, (Los Angeles office) Hose Kim, M.D. General Ortho, (Ontario - Inland Empire office) John Kayvanfar, M.D. General Ortho, (Encino office) John Kayvanfar, M.D. General Ortho, (Palmdale office) Chester Hasday, M.D. General Ortho ( Beverly Hills office) Rick Pospisil, M.D. General Ortho (Huntington Beach) Rick Pospisil, M.D. General Ortho (Santa Ana) Rick Pospisil, M.D. General Ortho (Riverside) Rick Pospisil, M.D. General Ortho (Monterey Park L.A. area) Rick Pospisil, M.D. General Ortho ( Long Beach ) Rick Pospisil, M.D. General Ortho ( Los Angeles office) ) Rick Pospisil, M.D. General Ortho (Huntington Park office) ) Rick Pospisil, M.D. General Ortho (Pomona )
Please select the Doctor from the following for Internal Medicine - Gynecology - Urology
None Any available Internal Medicine doctor with Garland & Associates before the decision date Paul Grodan, M.D. Internal Medicine (Ontario office) Paul Grodan, M.D. Internal Medicine (Beverly Hills office) Eli Hendel, M.D. Internal Medicine (Glendale office) Nellie Betancourt, M.D. Internal Medicine (Whittier office) Nellie Betancourt, M.D. Internal Medicine (Corona - Inland Empire office) Nellie Betancourt, M.D. Internal Medicine (Encino office) Emmanuel Brandeis, M.D. Gynecology (Beverly Hills office) Fred Kuyt, M.D. Urology - Sexual Dysfuncion - Cancer (Los Angeles office)
Please select the Doctor from the following for Ear nose and Throat - TMJ
None Alfred Roven M.D. Ear, Nose & Throat - Hearing Loss (Los Angeles office) Alfred Roven M.D. Ear, Nose & Throat - Hearing Loss (Downey office) Alfred Roven M.D. Ear, Nose & Throat - Hearing Loss (Woodland Hills office)
Please select the Doctor from the following for Neurology
None Any available Neurology doctor with Garland & Associates before the decision date Jay Jurkowitz M.D. Neurology (San Bernardino office) Jay Jurkowitz M.D. Neurology (Los Angeles office) Jay Jurkowitz M.D. Neurology (Orange office) Robert Shorr M.D. Neurology (Burbank office) Robert Shorr M.D. Neurology (Santa Clarita office) Robert Shorr M.D. Neurology (Lancaster office) Robert Shorr M.D. Neurology (Santa Barbara office) Robert Shorr M.D. Neurology (Solvang office) Robert Shorr M.D. Neurology (Oxnard office)
Please select the Doctor from the following for Psychiatry
None Any available Psychiatric doctor with Garland & Associates before the decision date Brian Jacks, M.D. Psychiatry ( Beverly Hills office ) Brian Jacks, M.D. Psychiatry ( Fresno office ) Brian Jacks, M.D. Psychiatry ( Oakland office ) Orlando Cartaya, M.D. Psychiatry (Santa Monica office) Orlando Cartaya, M.D. Psychiatry (Los Angeles office) Orlando Cartaya, M.D. Psychiatry (Encino office) Orlando Cartaya, M.D. Psychiatry (Gardena office) Scott Frazier Ph.D. Psychology (Los Angeles office) Scott Frazier Ph.D. Psychology (Encino office) Scott Frazier Ph.D. Psychology (Ontario office) Scott Frazier Ph.D. Psychology (Beverly Hills office) Scott Frazier Ph.D. Psychology (Bakersfield office) Howard Greils M.D. Psychiatry (Los Angeles office) Howard Greils, M.D. Psychiatry (Ontario office) Howard Greils, M.D. Psychiatry (Bakersfield office) Howard Greils M.D. Psychiatry (Santa Ana office) Howard Greils M.D. Psychiatry (San Bernardino office) Howard Greils M.D. Psychiatry (San Francisco office) Howard Greils M.D. Psychiatry (Sacramento office) Howard Greils M.D. Psychiatry (San Diego office)
Claimant Name
Claimant Address
Claimant Phone Number
Claimant date of birth
Claim #
Date of Injury
Type of Injury
Employer
Interpreter needed ? Please Select YES NO If yes, who will schedule interpreter Please Select Doctor office Claims Examiner Defense Attorney Applicant Attorney
Claims Examiner Name
Claims Examiner Phone Fax
Insurance Name
Insurance Address
Will you be sending cover letter ? Please Select YES NO Will you be sending Medical Records ? Please Select YES NO
Defense Attorney Name and Law Firm Name
Defense Attorney Address
Defense Attorney Phone # Fax
Applicant Attorney Name
Applicant Attorney Address
Applicant Attorney Phone # Fax
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