DATEOur File:< >

Please quote our file numberin all correspondence

< > < >

< >

< >

< >, < >Scanned and e-mailed to:

< >< >

ATTENTION: < > < >:

RE:< >, < >Your File Number: < >

We will send documents provided by your self to < > < > < > for review on the above-named claimant.

As a matter of company policy, we respectfully request a retainer/deposit in the amount of < > plus the GST, as well as the signed attached documents, and the Agreement to Pay form included in this confirmation letter by < >. Once the document review has been completed and the retainer received, your deposit will be adjusted accordingly.

If you have questions regarding any aspect of the above, please contact me at 1.800.290.2189 or communicate with me at appt.coord@westernmedical.ca. Any and all medical questions should be addressed to our Medical Director, Dr. Roger Hodkinson, at the same telephone number.

Thank you for the opportunity of being of service.

Sincerely yours,

Western Medical Assessments Corporation

Nicole Boon

Appointment Coordinator

attachs:Agreement to Pay form

Agreement to Pay Fees Within 30 Days

RE: < >, < >

My signature below will serve as my agreement to pay fees charged by Western Medical Assessments Corporation for services rendered, and to make payment for same within 30 days of the date of the invoice.

Fees that may be charged are in respect of services we will request of < > < > < > as necessitated by the matter involving < > < > < > and/or his/her solicitor and include IMEs, document reviews as well as, but not limited to, the signing of an Expert Witness Statement per the Alberta Rules of Court, Court preparation and testimony, no-shows/late cancellations, administrative, clerical and professional services, disbursements, etc.

I understand Western Medical Assessments Corporation is obliged by the CCRA to apply the Goods and Services Tax to the services it renders and is obligated by the Federal Government to request and receive this tax from all clients except provincial ones.

< >

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SignatureCompany Name

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Date