MEDICAL LEGAL EVALUATION INFORMATION

The Foot and Ankle Institute of San Francisco, the office of Bill J. Metaxas, DPM AACFAS, provides IME (Independent Medical Evaluations), AME (Agreed Medical Evaluations) and QME (Qualified Medical Evaluations) via Dr. Metaxas' certification as Qualified Medical Evaluator in the State of California.

  1. Podiatry and Foot and Ankle AME Agreed Medical Evaluations
  2. Podiatry and Foot and Ankle QME Qualified Medical Evaluations
  3. Podiatry and Foot and Ankle IME Independent Medical Evaluations

Online scheduling is available here.

The Foot and Ankle Institute of San Francisco is a paperless, secure, digital environment. Although our office does accept paper records, electronic submission is preferable. It's faster, and it helps the environment.

Records can be submitted securely electronically via the following methods:

  1. via secure email: records at faisf dot com
  2. via secure fax: 415-762-4243
  3. via secure upload through our contact page or ame/qme request forms

We offer prompt, thorough, comprehensive reports addressing recent decisions influencing apportionment, causation, and impairment ratings.

Qualified Medical Evaluation Scheduling Policies

  1. No appointment is scheduled until it is confirmed by our office. Unless our office sends a confirmation of the appointment date and time, submitting this form does not automatically constitute a scheduled appointment.
  2. There is a $500 fee that will be charged for no-shows or for appointments canceled within three business days. This charge is associated with code ML-100 to cover the office time block that is set aside for the appointment.
  3. Failure to send medical records prior to the date of the appointment will affect the examiner's ability to provide a comprehensive evaluation and report.

MEDICAL EVALUATION APPOINTMENT REQUEST - AME/QME

Please complete this form ONLY to request a Qualified Medical Evaluation or Agreed Medical Evaluation as governed by the Calfornia State DIR Division of Workers' Compensation.

For a general medical appointment, please use our appointment request form or our secure patient portal.

Qualified Medical Evaluation Policies

By submitting this form, you acknowledge that you understand and agree to the following policies:

  1. No appointment is scheduled until it is confirmed by our office. Unless our office sends a confirmation of the appointment date and time, submitting this form does not automatically constitute a scheduled appointment.
  2. There is a $500 fee that will be charged for no-shows or for appointments canceled within three business days. This charge is associated with code ML-100 to cover the office time block that is set aside for the appointment.
  3. Failure to send medical records prior to the date of the appointment will affect the examiner's ability to provide a comprehensive evaluation and report.
Requestor's Name

First Name* Last Name*
    
 
Who is requesting this QME/AME Appointment?
Injured Worker
Claims Representative
Attorney/Law Firm
 
Requestor's Email*
 
Requestor's Phone*
 
*
 
Requested Time
Morning
Afternoon
Evening
 
Injured Worker's Name

First Name* Last Name*
    
 
*
 
*
 
*

 

 
*
 
*
 


First Name* Last Name*
    
 
*

 
*
 
*
 
Is the Injured Worker above represented by an Attorney?
Yes  No
 


First Name Last Name*
    
 

 


 

 

 

* = Required Field