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Workers Compensation Referral Form

Please thoroughly complete this workers compensation referral form. We will be in touch with you as soon as possible.

If you prefer a paper form, click the button below and either mail or fax the form to our office (contact information is on the form). 

Download WC Referral Form
Referral Type
Medical Records: Please send chronological organized digital files to our office by your choice of a share drive or e-mail to: info@simongroupconsulting.com, or fax to (408) 971–9100 **To avoid report delays please send all AME, PQME, QME and PTP reports at least 30 days prior to the applicant’s Vocational Evaluation appointment. **
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