IWSN Independent Medical Examiners Feedback Form Question Title * 1. What is your name? Question Title * 2. What is your Claim number? Question Title * 3. What is your best contact number? Question Title * 4. What is your email or your postal address? Question Title * 5. What is the name of the Independent Medical Examiner you saw? Question Title * 6. What ws the date you recieve your notice to attend the IME (independent medical examiner) Please use the DD/MM/YYY format Date Question Title * 7. What was the date of your appointment? Please use the DD/MM/YYYY format. Date Question Title * 8. Did your notification include a reason for why the assessment was required? Yes No Question Title * 9. What were the reason/s given for the appointment? Question Title * 10. How long did the assessment go for? less than 30 minutes 30 minutes to 1 hour 1 to 2 hours 2 to 3 hours 4 hours or more Cant recall Question Title * 11. Did you bring a support person? Yes No Next