For your convenience, we provided two types of forms: Online & Downloadable.  The Online Forms can be opened and completed with Adobe Reader.  After completion, the "Submit Form" button will automatically attach your completed Form to an email addressed to webforms@gopromed.com.  The Downloadable Forms must be printed, completed and Faxed per instructions below.

ONLINE FORMS

•  MSA Service Request
•  Florida UR Service Request
•  Liability Service Request
•  Medical Valuation Service Request
•  Medical Claims Analysis Service Request
•  Medicare Secondary Payer Mandatory Reporting
•  IME Preparation Service Request
•  Cost Projection Service Request
•  Life Care Plan Projection Service Request
•  Medicaid Reporting Service Request
•  AIG Medical Cost Projection Service Request
•  IME Preparation Service Request

•  General Release of Information
•  General Release of Information Liability
•  SSA Consent Form
•  Medicaid Release Form

For downloadable forms only, select the form of your choice, download, print, and complete the form and fax to (407) 599-1994.  Our specialists will process your request as soon as possible. 

To view these files, you will need  Adobe Acrobat Reader installed on your PC.   If you do not have Adobe Acrobat Reader installed on your computer, click on the Adobe button below.

For additional information from the US Department of Heath & Humans Services click below.