Shopping CartYour Cart is EmptyQuantity: RemoveSubtotalTaxesShippingTotalThere was an error with PayPalClick here to try againThank you for your business!You should be receiving an order confirmation from Paypal shortly.Exit Shopping Cart Insurmed Services Here to serve you! NOW COVERING ALL OF DALLAS-FT WORTH Office #592 SuffixMr.Mrs.Dr.Ms.Jr.IIIIIClients Name (First)*Clients Name (Last)*Birth Date: (MM/DD/YYYY)Gender (Male/Female)Tobacco (Yes/No)Email:*PLEASE CHOOSE FROM THE FOLLOWINGLIFEDISABILITYOVERHEAD DILONG TERM CARETypeOption 1Option 2Insurance Company: (First/Second) Policy Amount (First/Second) Policy number:Agency/Brokerage (First/Second)Agents NameAgent Code (First/Second)-Please ProvideAgent Phone/FaxAgent Email:Exam Requirements:*Use State GuidelinesParamed/Bld/Urine/EkgParamed/Bld/UrineParamed-onlyUrine-onlyBlood-OnlyEkg-onlyParamed/UrineBld/UrineVitals/Bld/UrineVitals OnlyUrine repeat (1 day)Vitals/Bld/Urine/EkgUrine 2 consecutive daysSee CommentsPreset Time: (This is the time the applicant would like to be seen)Preset Date: (This is the date the applicant would like to be seen)Preset Location (Location where applicant would like to be seen)Work AddressHome AddressOther (See Notes)Comments:*(HOME)-Clients Street address:Apartment/Unit #City:State-Zip Code:Home Phone:Mobile Phone:(WORK)-Clients Street Address:Suite/UnitCity: State-Zip code:Work Phone:Order was submitted by: Name/Email and or Phone #This site uses Google reCAPTCHA technology to fight spam. Your use of reCAPTCHA is subject to Google's Privacy Policy and Terms of Service.SendThank you! Your information has been submitted successfully. We appreciate your business! ***** Please be sure to check status of your order in 48 hours if you have not received and auto generated email from the Exam One Portal ******Toggle NavigationHomeServicesWhat is a Paramedical Exam?About UsContact UsPlace online order Employment AffiliationsAnnoucements! (Please Check)HomeServicesWhat is a Paramedical Exam?About UsContact UsPlace online order Employment AffiliationsAnnoucements! (Please Check) / PreviousNextPausePlayClose