Attorney's First Name: *

Attorney's Last Name *

Phone Number *

Email Address *

Requested Completion Date:

Reason for Request

Client Information:

Client's Name:

Client's DOB:

Client's DOI:

Client's Phone:

Client's Email:

REPORTS:

(PLEASE CHECK ALL THAT APPLY)

Full Life Care Plan Option

(Includes Expert Medical Opinion Report) - $15,000

Expert Medical Opinion Report w/ Future Care

Pain Medicine (Spine) - $5,000

Neurology - $6,000

Extremity Orthopedics - $5,000

Other Report Request:

Expert Trauma (PTSD) Report - $5,000

Economic Loss - $5,000

Present Value - $1,500

EXPERT REQUEST AGREEMENT:

LegalStream and its affiliate agree to complete all work by the requested deadlines. Any necessary changes will be discussed and agreed upon by LegalStream and its affiliate and the requesting legal entity. The requesting legal entity agrees to pay all invoices by the agreed-upon date.

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Date Signed: *