Intake form

Help us serve you better

Name *

Email address *

What service are you interested in?

Please select at least one option.

Expert witness reports

Functional capacity evaluations

Second opinions for disputed claims

Occupational injury analysis

Telehealth assessments

Please describe the nature of your inquiry.

What is your preferred method of communication?

What is your location?

How did you hear about InCharge healthcare?

What is the urgency of your request?

If applicable, please provide any case reference number.

Additional questions or comments

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InCharge Healthcare