Disability Form Information

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Doylestown Women’s Health Center has a generic disability form that we will provide you at no charge.  However, if your employer requires their company’s form to be completed there is a $20.00 charge.  If your employer or disability company requires additional forms (family leave forms), there will be an additional $10.00 fee per form.

Should medical records be required you will be charged in accordance with the guidelines set by the Pennsylvania Department of Health as follows:

Pages 1 - 20 $1.46 per page
Pages 21 - 60                     $1.08 per page
Pages 61+ $0.37 per page

 

Payment is expected at the time forms are handed in. You will be advised of any additional charges (in the case of medical records) once those have been calculated.  Payment for any additional records or forms must be received prior to the release of the forms.

Please allow 7 to 10 days for completion of all necessary forms.  You will receive a call when all forms are completed.