Have an appointment? Here’s what to expect.
Please print/download and complete this before your upcoming evaluation. Please bring it with you to your evaluation or upload completed form below.
If you prefer to complete it digitally, please call us at (408) 445-8400 so we can email or text it!
Why am I here?
You are here for an evaluation only; not to receive treatment.
What is the purpose of the evaluation?
To address any disputes affecting your case.
Who requested this evaluation?
For workers’ compensation cases:
Unrepresented (no attorney): You may have selected the evaluator off a panel list that was randomly generated by the Division of Workers’ Compensation (DWC).
Represented (attorney): Each party gets to remove one (1) name off the panel list and the last name remaining is selected as the panel Qualified Medical Evaluator (QME) or the parties agreed upon the evaluator, and this is called an Agreed Medical Evaluation (AME).
For non-workers’ compensation cases:
You are most likely being evaluated because a party has questions about your injury.
In some cases, each party will have their own evaluator(s).
In other cases, a neutral third party selected your evaluator.
Who do you work for?
We are objective and our expert opinions are often used to move your case along to some type of resolution.
Why will I be called and asked questions before my appointment?
A historian may call you to obtain some information prior to your appointment. This call is to help the doctor get an understanding of your unique situation before you come to our office.
How long will the evaluation take?
Anywhere from 1 to 4 hours so please plan accordingly. Feel free to bring snacks and something to drink! Please try to arrive early for your appointment. Late arrivals may need to be rescheduled.
Do I have to fill out paperwork?
In some cases, questionnaires are necessary and may need to be completed in advance.
Why do I have to take assessments?
Assessments help paint the picture of your case and provide additional information to the evaluator. Assessments help us understand how the injury has impacted your quality of life and activities of daily living.
What should I wear?
Comfortable clothes and shoes that you can move in. If you have an injury to your lower body, please wear or bring shorts.
Can I bring my children?
Please do not bring non-adult children to your evaluation.
Can I bring a friend or adult family member?
Yes. They are welcome in our offices. However, for some evaluations, they will not be able to attend the assessment or interview process.
What if I need an interpreter?
If you do not speak English as your primary language, a certified interpreter will be provided by one of the parties. We do not schedule interpreters. If a certified interpreter is required, but does not show, the evaluation will be rescheduled.
I am really nervous about the evaluation. What should I do?
Relax. The purpose of the evaluation is to review your history and any medical records, examine you, and address any disputes. If you do not recall the specifics of your history, that is ok. This is not a memory test. Do your best. Your evaluator will help guide you through the process.
What is a party?
You, your employer, the insurance carrier, a third-party administrator, and attorneys.
Will I get reimbursement for travel expenses?
For workers’ compensation cases, please call your attorney if you are represented or your claims adjuster if you are not. They can provide additional information.