Where will this service take place?
* Employer Email will receive a copy of this submission
** If Yes is selected, please fill out the remainder of the section.
Please include your waybill if you require the documentation to be returned.
If a return waybill is not provided, the documentation will be destroyed 30 days after the assessment.
Scheduling of Appointment
Terms and Conditions
- A file opening fee may be charged to Client, to include but not limited to Medical Director’s fee; admin and/or clerical time; long distance and other disbursements.
- Payment for services rendered is due upon receipt of invoice, net 30 days. Payments are to be addressed to Western Medical Assessments, 17204-106A Avenue, Edmonton, Alberta, T5S 1E6.
- Any late cancellation (date will be stipulated in our letter with Appointment details) or no-show fee is the Client's responsibility to cover, terms as in number 2) above.
Upload a File
How to Attach Files to Your Submission:
- Click "Add Files" and the browse for the documents you need to upload. We allow pdf, doc, docx, xls, xlsx, csv, txt, rtf, html, zip, jpg, jpeg, png and gif files.
- Maximum file size permitted is 10 MB
- To send larger files or more than 3, please use a file sharing service like DropBox.com and provide a link to email@example.com
Kindly Note: You will be emailed a copy of your submission to the address entered in the "Client Email" field