Forms

FMLA | DISABILITY | LEAVE | ACCOMODATIONS

The purpose of this form is to provide assistance in the completion of your FMLA/Disability paperwork. We ask that you answer each question to the best of your knowledge, keeping in mind that you may skip questions or sections that do not pertain to your unique situation.

Because the FMLA and Disability forms require a significant amount of time from both support and clinical staff, there are charges. For established patients (patients who have been with our practice more than 90 days) a $200 fee for Disability and $65 fee for FMLA paperwork completion must be paid upfront. For new patients the fee is $300 and $100.