Neurosurgical Evaluations of the Carolinas

New patient request form

Page 1 of 3

Information for Scheduling an Independent Medical Evaluation (IME) with Dr. Curling

  • Please note that all new patient referrals to our office for cases that involve medicolegal issues (worker’s comp, personal injury, med mal, etc.) are scheduled as independent medical evaluations—whether for the purpose of addressing causality, 2nd opinion on a rating, 2nd surgical opinion, to determine MMI or work status, etc. The purpose for this is twofold—the first is that evaluation for any of these issues truly requires and deserves a thorough and objective evaluation by an independent evaluator. Even if just for the purpose of providing additional opinion on a PPI rating, it must first be determined whether or not the patient is at MMI, which requires that one first establish a clear diagnosis and then determine whether all appropriate diagnostic and therapeutic options have been exhausted, etc. As such, even though the report may just address a rating, to thoroughly and appropriately address the issue, an extensive review of all records and studies and a thorough evaluation of the patient is required.
  • The second reason that all new appointments are scheduled as IMEs is that Dr. Curling does not automatically accept patients for treatment—all new patient appts are for evaluation only. This serves to maintain an objective and independent position during the evaluation. However, in some circumstances, Dr. Curling may be available to assist with further evaluation and treatment following an IME, though this will usually be limited and will be viewed as a follow up to the IME to help complete the recommended evaluation and treatment necessary to achieve MMI. This option may be available if the patient has been released by his/her treating physician, and it is the desire of all of the appropriate parties (especially the patient). However, no treatment will ever be initiated at the initial IME appointment; only after all parties have had an opportunity to review the evaluation report may further f/u be requested, if desired.
  • Dr. Curling does not require a review of the records prior to scheduling or requesting an IME. However, please note that Dr. Curling will strictly limit his evaluation to neurosurgical issues (brain, spine, and peripheral nerve injuries), and does not delve into areas beyond his area of expertise. If you have questions regarding the appropriateness of a particular referral, you may wish to contact us to discuss the case, and/or fax a few pertinent records for review, following which we can let you know whether Dr. Curling may be able to assist with the case.
  • Prepayment is required for all IME appointments. Following receipt of the scheduling information (page 3 of this notice), an authorization letter detailing all of the pertinent information will be faxed to the individual identified as the payor for the service (adjuster, attorney, etc.). That signed authorization letter and prepayment must be received back in our office no later than 7 days prior to the appt, or the appt will be cancelled. If that is necessary, the appt will not be rescheduled until that information is received.
  • Records must be received at least 2 days prior to the appointment, via fax or mail. Dr. Curling prefers that all available records be received for review, not just a few edited notes. However, please do not send stacks of records filled with multiple copies of the same report, and please make some effort to organize the records, preferably chronologically with the most recent on top. Radiographic studies may be mailed or delivered prior to the appointment, or may be brought at the time of the appointment. At present, all correspondence sent prior to the scheduled appointment should be mailed/faxed/delivered to the Kernersville office.
  • We do charge a fee for no shows or cancellations within a 48 hour window. If the patient is more than 30 minutes late for an appointment, it will be considered a no show. That fee will be billed to the payor and must be paid before the appointment can be rescheduled. If there are two no shows or late cancellations, the appointment will not be rescheduled in this office.
  • IME appointments are scheduled for a 2 hour time slot. Dr. Curling does not permit case managers, attorneys, etc. to accompany the patient during the evaluation. However, if these individuals do wish to accompany the patient to the appointment, Dr. Curling will gladly sit down with you/them and the patient following the evaluation to review the initial findings of the evaluation. If you wish to arrive late for the appointment to minimize your wait, you may generally plan to arrive about one hour after the scheduled time. As an alternative, you are welcome to wait in the privacy of our conference room during the evaluation to catch up on work, calls, reading, sleep, etc.
  • Reports will generally go out within a few days of the appointment if all of the necessary information is available at the time of the appointment (i.e., records, Xrays, etc.). Please don’t start calling, faxing, or emailing for reports, unless you have not received it within 2 weeks of the appointment. In most instances, a “10 day guarantee” will apply (i.e., report in 10 business days or no charge)—this is addressed further in the authorization letter.
  • Please complete all of the information on the following request sheet and return it to our office via fax or mail. If sections do not apply, you may mark “N/A”. Please indicate whether you prefer the Charlotte, Kernersville, or New Bern office. Pay particular attention to the fax number for the authorizing individual and payor for the service (usually the adjuster), as the authorization letter will be faxed to that individual. Wrong names and fax numbers for this individual sometimes result in cancellations of the appointments as the necessary information is not received back within the 7 day window. If you are not the payor and are assisting with the scheduling process, you may wish to notify that individual to “be on the lookout” for the authorization form from our office and encourage them to return the form and prepayment expeditiously.
  • Please note that additional information regarding scheduling, Dr. Curling’s background, directions to the offices, etc. is located on our website—

Please complete all of the requested information and return to our office via mail or facsimile—Jan will contact you thereafter to proceed with scheduling an appointment. Please type or print legibly. Please confirm adjuster contact info, especially the fax no., as errors in this information often account for cancellation of appointments, due to failure to receive authorizations, etc.. If attorney or case manager info is not applicable, you may mark as “N/A”. Thank you. Note that all correspondence should be directed to the Kernersville office.

Patient Name:APPT DATE: (TBA)

Address:APPT TIME: (TBA)

Kernersville Charlotte New Bern

Phone #:Appt made by:

SSN: Pt Pl. Atty D. Atty CM Adj 3rd party

Birthdate: Other

DOI:Case manager attending appt? Yes/No

Problem/Diagnosis:

Adjuster/Payor Name:Carrier’s Attorney Name:

Company: Practice name:

Address: Address:

Phone #: Phone #:

Fax #: Fax #:

Email address: Email address:

File no:

Case Manager Name:Patient’s Attorney Name:

Company: Practice name:

Address: Address:

Phone #: Phone #:

Fax #: Fax #:

Email address: Email address:

We need to receive (please circle anticipated method of delivery):

Records: Pt to bring/fax Atty to mail/fax/email Adjuster to mail/fax/email CM to bring/mail/fax/email

Xrays: Pt to bring CM to bring To be mailed

Prepayment and authorization returned by adjuster/payor 7 business days prior to appt