Evaluation Feedback Page

Appointment

Due to the tremendous amount of e-mail
that we receive,
this form is only for
making an appointment.
You must specify an appointment date
in your e-mail below
for a reply.

       What Type of Fee Based Services Do You Need?
        Check ALL that apply.
        If you do not know, Click Here

        Spinal Impairment Rating
        Convert Whole Person Impairment to Regional Spine Impairment
        Functional Capacity Assessment
        Spinal Disability Evaluation
        Chronic Pain Syndrome Rating
        Independent Medical Exam (IME) Second Opinion
        Work Restriction Documentation
        Lost Pre-Injury Capacity Documentation
        Scoliosis Impairment Rating
        Regional Scoliosis Impairment Rating
        Case Review - File Review
        I Don't Know
        Other

Contact Information

Name
Address
Telephone
E-mail

GENERAL DISCLAIMER: The information contained on this web site is not intended to alleviate, improve, maintain or cure medical and/or non-medical condition(s). This material does not constitute medical and/or legal advice. By using this web site, the user understands that they are not entering into a doctor and patient relationship. A doctor and patient relationship is only entered when a person completes the Terms of Acceptance and the appropriate paperwork and has a face-to-face meeting with Dr. Gerald R. Lapinsky, DC, CSDE, DABDA. This web site is intended for informational purposes only. Consult a licensed physician for specific recommendations and treatment. The subscriber agrees to indemnify and hold harmless Dr. Gerald R. Lapinsky, DC, CSDE, DABDA and/or DisabilityEvaluation.com and its individual contributors from any claims resulting from the use of the service which damages the subscriber or any other party. We reserve the right to make changes to this web site at any time without notice. We also reserve the right to refuse service to anyone.

What Type of Fee Based Services Do You Need? Check ALL that apply. If you do not know, Click Here

Contact Information

What Type of Fee Based Services Do You Need?
Check ALL that apply.
If you do not know, Click Here