< ><<file number>><<Claim Number>>

Insurance / Legal

Delivered by courier

<

<

<<CITY/PROV>>

< >

Dear <

RE: < > <CMFirst>>

DOB:< >

DOL:< >

Date/Time: < >@ < >

Report Due:

You previously saw this person for the purpose of an <<Independent Medical Examination.>>

OR

Thank you for agreeing to see this person for an Independent Medical Examination.

OR

The finalization of your report was pending receipt of additional medical documentation.

Please note there is a tight deadline of <<deadline date>> for this report.

We enclose the additional medical documentation that has been sent to us.

When preparing your report, could you please address it to: < > of CLCompany>> and please quote our client’s file number.

PLEASE ENSURE THAT YOUR ADDENDUM AND INVOICE ARE SENT TO WESTERN MEDICAL ASSESSMENTS.

Thank you for providing your services in this matter.

Yours sincerely,

Western Medical Assessments Corporation

Roger Hodkinson M.A., M.B. (Cantab), FRCPC

Medical Director

RGH/sz

Encls.