Our office receives many requests for completion of forms. This requires extra work, time and financial resources in excess of what is normally needed to complete the medical record. We typically charge a prepaid fee of $10.00 to complete a form.

Please submit your request for completion of forms well in advance of when they are needed. We will attempt to complete the forms as quickly as possible however, accurate completion requires adequate time to review your records. It may take up to 7 – 10 business days to complete a form.  

The following charge list is not exhaustive. If you have a form that is not listed, please bring it into our office to determine whether we can complete this on your behalf and if a charge is applicable.

Type of Form Charge
Short Term Disability $10.00
FMLA – Family Medical Leave Act $10.00
Other Attending Physician Statement $10.00
ADA – Americans with Disability Act Accommodation $10.00
Fitness for Duty No Charge
School Medical Excuse No Charge
Handicap Parking Placard No Charge