Patient Forms and Letter Completion Fees
An administrative fee will be charged for the completion of patient forms. Patients may choose to pay $100 annually, which will cover completions of all forms for a period of one year OR pay $25 per request (5 pages is considered one form/ request).1 School Medication Forms and Treatment Plans will be made available at NO charge; however, requests for replacement or duplicate copies may be charged a fee of $25.
| Fee Options | Description | Amount |
|---|---|---|
| Option 1: Annual | Fee charged for completing all forms/letters for a period of 1 year. | $100 |
| Option 2: Ad Hoc | Fee charged for individual request. | $25 |
Types of forms completed include the following:
- Permanent Disability Form
- Short Term Disability Form
- FMLA Paperwork
- Letters
- Various School/ College Forms
- Other forms: Please call the office for forms not listed.
Patient must be current on office visits for forms to be completed. Please allow up to one week for pickup of completed forms.
1 Administrative fees will not be charged for patients with Medicare, Medicaid, or Tricare insurance. Admin fees will not be charged for completion of payer required forms.