Work Capacity Guides Impairment Ratings
Neck Mid-Back Low Back Arms and Legs
Have you been to a doctor for
Did you ever have an Impairment
Are you currently being represented
your question's and the related facts
I understand that the information I have given on this form is true and correct. I also understand that it is illegal to give false and/or fraudulent facts about my condition to this office. If at any time it is determined that I have given fraudulent information regarding a medical or non-medical condition regardless of the intent, I understand that I will be prosecuted to the fullest extent of the law under federal, state and local statutes.
Dr. Gerald R. Lapinsky, DC, CSDE, DABDA
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