Please review our Administrative and Forms Process

We recognize that managing administrative tasks or paperwork can be challenging, especially when undergoing medical treatment. We are committed to assisting you in easing this process while adhering to necessary guidelines. These guidelines ensure that all forms are accurately and promptly completed.

However, please note that there are certain forms we cannot complete due to specific exclusions. Also, be aware that form completion may incur fees as your insurance might not cover this service. Please continue reading for a detailed understanding of our administrative process.

Tasks completed by you (the patient)

Insurance communication beyond basic eligibility and verification
General medical records requests by the patient or by other clinics, hospitals, etc -
- Printed: $25 for the first 20 pages, then $0.50 for every page after
- Electronic: $25 for 500 pages or less and $50 for more than 500 pages
- Imaging studies - $8 per copy of an imaging study.
Execution of an affidavit - $15 may be charged for executing an affidavit

Tasks that only require a medical visit without additional fees

Request to appeal or renew specialist referral authorizations and prior authorizations for non-formulary meds
Physician letters for work excuses and release back to work for a condition treated in our office
Medical Procedure Pre-Surgical Evaluation - Requires an office visit. Only completed for patients established for 12 months or more

Tasks that require a Medical Office Visit and additional fees

FMLA forms $75- specifically pertaining to the problem addressed in the PCP visit, excludes specialist’s diagnoses. Physician pre-approval must be requested.
Medical Accommodation forms $75 - completed for work or school, excludes specialist’s diagnoses. Physician pre-approval must be requested.
Physician letters $75 - Specific requests for letters. Excludes work excuses and release back to work. Physician pre-approval must be requested.
DMV Handicap Placard Forms - $25 plus the additional notary fee
Life Insurance Exam and Medical Records - the third party requesting the records covers the cost. We will follow the guidelines outlined by the TMB for calculating the cost of furnishing your medical records.
Medical Records Requested by Legal Entity/Lawyer - the third party requesting the records covers the cost. We will follow the guidelines outlined by the TMB for calculating the cost of furnishing your medical records.
Sports Physical Exams with form completed within 5-7 business days. $70
General school/work Physical Exam forms completed within 5-7 business days - $25 with a preventive exam
Insurance exception requests for an out-of-network facility referral or treatment. Additional fees may apply. $150
Expedited forms & form revision requests - add $25 to any of the fees listed

Tasks that are not completed by our office

Elective Cosmetic Procedure Pre-Surgical Evaluation
COVID Vaccination Exemption forms or letters
Emotional or medical pet forms or letters
Evaluation for disability or injury for work, legal, or disability benefits

Disclaimer: We do not charge a fee for a medical or mental health record if the request is related to a benefits or assistance claim based on the patient's established disability.