Our office will complete medical information on forms for our patients.  We do charge a fee for this service based on the complexity of the form and the physician time required to provide pertinent medical information.  The minimum fee is $5.00; for Family Medical Leave Act (FMLA) forms the minimum fee is $25.00. 

You will need to fill out a Request for Form Completion before we will provide this service.  You may print a copy of the form below.  The request form and the document you want completed may be faxed to our office at 757-838-0612 or you may drop off the documents at our office during normal business hours. 

There is a seven day turn around for completion.  We will contact you when the documents are ready for you to pick up.