Patient Forms


We are part of Tower Health’s electronic medical record called “EPIC”. You may access your records by visiting Tower Health’s My Chart at



A pre-payment of $25 is required for each form we receive for completion. After receiving payment, and proper authorization, the form(s) will be completed in 7-10 days.

Many forms do not include authorizations to release the information from your medical record.

Therefore, we may need an “Authorization for Release of Medical Information for purpose of disability/ FMLA” form, prior to processing.

Many forms come directly to our office from the disability company or employer via fax. In these scenarios, we will contact the patient with further instructions regarding authorizations and pre- payment.

When completed, the forms will be faxed directly to the requesting company.