PI Referral Download: PI Referral Form or Fill in the form below: Referring Attorney: Please specify any special requests, upcoming litigation dates, deadlines, etc.: Please outline the scope of assignment: Plaintiff’s Name: Plaintiff’s Address (please include city, state, zip): Plaintiff’s Telephone Number/Email Address: Venue/Case Number: Plaintiff’s Attorney’s Name: Firm Address (please include city, state, zip): Telephone Number/Fax Number: Email Address: Defense Attorney’s Name: Address (please include city, state, zip): Telephone Number/Fax Number: Email: Medical Records: MailedE-mailedOther [group medical-recordother][/group] Please send chronologically organized digital files to our office via your choice of share drive or email to: info@simongroupconsulting.com or fax to (408) 971 -9100 ADDITIONAL SERVICES: Interpreter Needed? —Please choose an option—YesNo [group interpreterneeded-yes] If so, language: [/group] Will your office be setting up the interpreter services? Comments:
