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Eval Specialists Sign Up Information

Last Updated:

2/11/2020

Site Encrypted:

Yes

Site Category:

Email Verified:

VISIT SITE VIEW PRIVACY POLICY VIEW TERMS OF SERVICE

48/100

Data Held

Email Address

Date of Birth

Your Address

Home Address, City, State, Zipcode

Phone Number

Home Phone

Post-Registration Data

We are still gathering data about this website

Validation

This site did not show evidence of storing passwords in plaintext.

This site does allow secured connections (https)

This site did show a clear way to unsubscribe from their emails

This site does verify your email address.

Membership Emails

Below is a sample of the emails you can expect to receive when signed up to Eval Specialists.

IME Referral Form...

Claimant Information
Claimant:*	Home Phone:
Address:*	DOB:*
City:*	SS#:
State:*	Zip:*
If Evaluation Specialists is sending the scheduling letter:
Claimant Attorney:	Address:
City:	State:
Zip:
Claim Information
Employer:	DOI:
Job Title:	WC: Auto: LIA: Other:
Type of Injury:*	Claim Number:*
Examination Information
Reason for Examination: Jon	Date Exam Needed By:
Speciality or Physician Requested:	Location:
Case Manager Attending Yes No	Eval Specialists Sending Notification Letter to Patient? Yes No
Address Report To
Your Name:*	Phone:*
Company:*	Fax:
Address:	Email:
City:	State:
Zip:
Billing Information (if different from above)
Name:*	Company:*
Address:	City:
State:	Zip:
Phone:*	Fax:
Additional Information
Jon

Raw Data Registration Structure Registration Form Text

Registration

Printer Friendly Claimant Information Claimant:

Title

Phone (home)

Home address

City

State

Zipcode

Date of birth

WC:

Auto:

LIA:

Other:

Case Manager Attending

Yes

No Eval Specialists Sending Notification Letter to Patient?

Yes

Data Name	Data Type	Options
Printer Friendly Claimant Information Claimant:	Text Box
Title	Text Box
Email	Text Box
Phone (home)	Text Box
Home address	Text Box
City	Text Box
State	Text Box
Zipcode	Text Box
Date of birth	Text Box
	checklist	WC:
	checklist	Auto:
	checklist	LIA:
	checklist	Other:
	option	Case Manager Attending
	option	Yes
	option	No Eval Specialists Sending Notification Letter to Patient?
	option	Yes

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Comment by: admin

Comment on: 01/09/2020