FORMS COMPLETION POLICY
The only documentation regarding your health or illness required by law (and included in the office visit charge) is an office visit note.
Completing paperwork for Schools, Camps, the Family Medical Leave Act (FMLA) claims, Long-term care, life insurance, the Department of Veterans’ Affairs, disability claims or other purposes is unnecessary duplication and goes beyond routine medical care. Therefore, it cannot be billed to your insurance company. Since all forms require our signature, we are personally responsible for the accuracy of the information provided. Incomplete or inaccurate information may have far reaching consequences for your case. Filling out forms thus requires careful consideration and considerable amount of our time.
Therefore, it is our office policy to charge for the completion of any form as follows:
- Processing fee of $25 per form, and
- Completion fee of $5 per each page
- We cap the charge at $50 maximum per form. We will complete the form and fax it to the designated recipient (or return it to you if you prefer) within 2 business days of the receipt of payment.
If you would like us to complete a specific form, please download the Request for disclosure and payment for medical form(s) (see the Forms tab at this website). To avoid delays, please return the form with payment.
If the form to be completed was sent to us by an organization, we will notify you of the exact amount that is due. We may also request completion of the Authorization to Disclose My Health Information. The form will be completed and sent to you (or the requester) within 2 business days after the payment is received.
You can avoid being charged for the form completion by requesting that the requester accepts a copy of the office visit note in lieu of a form. (For example, there is no requirement to use the FMLA form by employers. The employer just needs to know that the medical condition is real and qualifies for FMLA leave.) We can send to the designated recipient a copy of the last office note free of charge. If you wish us to do so, please fax us a signed Authorization to Disclose My Health Information. (To limit what is disclosed, please make sure that you fill out the condition and/or indicate start and end dates.)
Finally, completion of certain forms, such as office leave, accommodation or disability forms may require an update of your medical information or a special evaluation. In such cases, you will be asked to make an appointment and we will fill out the form as part of the office visit without extra charge.