top of page

Patient Forms, Notices, & Policies

Disability and Paid Family and Medical Leave Forms

Disability forms take time to complete. It may be necessary for you to schedule an appointment with the physician or physician assistant to review and complete the form. Please complete the entire employee/insured section of the form. Include a separate explanation for our review if you have additional information that would be helpful in completing your form. Please drop off the form to our office. We do our best to turnaround disability and PFML forms in 7-14 business days; however, it can take longer depending on the volume of forms to be completed. The office will inform you if there is a charge to complete your forms.

Medical Records Request

A medical record request form must be completed and submitted via mail, fax or in person. Please allow a minimum of 10-14 business days for processing. A fee may apply and will vary depending on the number of pages released. Under HIPAA a physician has 30 days to provide the patient or the patient's representative with a copy of the requested medical records; however, if the medical records are not maintained or are not accessible on-site, then a physician has 60 days to provide the records.  > Download Form

Surprise Billing Protection Notice

Reference Notice for full details.  > Download Form

bottom of page