Florida Claims Management

Florida Claims Management

Referral Forms

We now have online applications for both IME Request Forms and Peer Review Request Forms.

You can either download a PDF Document for either form and fax it to us, or you can fill out either form online, and it will be emailed directly to us. 

Please note: When completing referral forms, please specify MD or DO. While the specialties may be the same, the licensing chapters are different.  (MD-Medical Doctor,  DO- Osteopathic Physician)

Download PDF Document

This will download a PDF file which you can complete and fax back to us.

Fill out online

Use either form to have your request automatically emailed to our representatives.

IME REQUEST FORM IME REQUEST FORM
PEER REVIEW REQUEST FORM PEER REVIEW REQUEST FORM

 

 
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Florida Claims Management

21326 Coakley Lane
Land O Lakes, FL 34639
1-800-893-7579
813-948-8801
Email Us
Fax 813-948-8875