APPLICATION FOR INDEPENDENT MEDICAL EXAMINERS

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1. Contact Information & Professional Designations

Your Name*
Professional Title
Your Address*

2. Medical Specialties

3. Experience in the Practice of Medicine

Please enter a number greater than or equal to 1.

4. Board Certifications

Do you currently hold any board certifications?

5. Nature of your Medical Practice

6. IME Formal Training

Have you successfully completed formal training in the performance of IMEs and/or impairment evaluations through the International Academy of Independent Medical Examiners (IAIME) or American Board of Independent Medical Examiners (ABIME):