< ><<File No>><<Claim #>>

Insurance / Legal

Delivered by courier

<

<

<<CITY/PROV>>

< >

Dear <

RE: < > < >

Our File:<<File No>>

Claim Number:<<Claim #>>

Report Due:<<report due date>>

Imaging Review

Thank you for agreeing to provide an <<imaging review>> on this person.

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

We have enclosed all documentation that has been made available to us. Please see the attached letter from our client, < > of CLCompany, dated DATE with background issues and questions to be addressed in your report. Please respond in a question and answer format.

When preparing you report, could you please address it to: < >, < > and please quote the above referenced claim number.

PLEASE ENSURE THAT YOUR INVOICE AND REPORT ARE SENT ONLY 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.