CNS IME INTRODUCTION AND FEE AGREEMENT 

 
Please download the PDF below ONLY if:
 
1) You have filled out a Consultation Request Form (if you have not click here)
2) You have spoken with Dr Zigun and you have agreed to the consultation
 
 
CNS IME INTRODUCTION AND FEE AGREEMENT
 
1) Click Here to Download IME Introduction and Fee Agreement 

2) Complete the form, initial, sign, and date where indicated  
 
3.  Scan forms and return to Dr. Zigun by uploading via HIPAA grade
     encryption via  HushMail.com  Click Here
 

Comprehensive Neuropsychiatric Services. LLC PO Box 100193 Milwaukee, WI 53210 

© 2016 Comprehensive Neuropsychiatric Services, LLC.  Proudly created with Wix.com