• Home
  • About
  • Clients
    • Submit a Referral
  • Providers
  • Claimants
  • Contact Us
Logo - Read Reports, Medical Review Services

medical review services

Complete the form and submit below:
For your protection, all data is encrypted by our secure SSL server.

Fields marked with an (*) asterisk are required

Step 1 of 2

50%
  • MM slash DD slash YYYY

  • CLIENT INFORMATION

  • Full Name

  • CLAIMANT INFORMATION

  • Full Name
  • Street Address
  • MM slash DD slash YYYY

  • CLAIM INFORMATION

  • Include Address
  • Include Address
  • Include Address
  • MM slash DD slash YYYY
  • Specify right or left
  • Specify right or left

  • PARTIES OF INTEREST (WHO YOU WANT US TO COPY ON THE IME PAPER WORK)

  • Include Address
  • Include Address
  • Include Address
  • Include Address
  • Include Address
  • Include Address
  • Include Address

  • SERVICE REQUEST (CHECK ALL THAT APPLY)

  • TYPE OF CLAIM

  • SPECIALTY REQUESTED

  • ISSUES TO BE ADDRESSED (CHECK ALL THAT APPLY)

  • SUMMARY OF CLAIM

  • This field is for validation purposes and should be left unchanged.
Read Reports, Inc. · Copyright © 2023 All Rights Reserved
Privacy Policy | Terms of Use
Site Design

60 Park Ln., #6, Highland, NY 12528

OPEN MON - FRI 8AM - 4:30PM
CALL: (845) 255-3267 Receptionist ready to take your call.