Referral

If you have previously submitted a referral for this claimant and would like to retrieve the data from that file, please enter D&D case number and click search. Please be sure to verify the data extraction and update accordingly prior to new referral submission.

Claimant
Exam

Claimant Attorney
Treating Doctor
Send Report
Please complete this section for additional correspondence with Defense Firm, and or 3rd Party Billing information
Questions

Check questions that need to be addressed by the examining physician



Additional questions to be addressed:

(2000 character limit per question)
Medical

Please specify what types of material(s) will accompany this request and how they will be provided.

Select Material Mode Comments
No Medical       
      
      
      
Documents
Films
Photos
Video
Molds

Please select medical record files to be uploaded to D&D Associates

After selecting the file, please click on the [Upload Files] button. To select multiple files use the Ctrl or Shift keys.