Independently Owned and Operated since 2004
Forms

Forms, Letters, Handicapped Tags

You may require forms or letters to be completed by a provider.

Completion of forms requires administrative time to gather data, physician time to review and time to complete the form. We have an established form completion policy. We are not obligated to complete these forms. We reserve the right to refuse to complete any form. If records are requested, in addition to a completed form, then the form will be sent from our office once payment has been received from the company requesting this information. No forms or records will be sent to a third party without a signed release from the patient.

  • You must be an established patient, we cannot complete forms until you have been seen in our office at least 3 times.
  • Forms cannot be completed on the day presented to the office unless you have scheduled an office visit specifically for forms completion. When you schedule your appointment, inform the scheduler that you have forms.
  • Blank forms will not be accepted. Personal information needs to be completed.
  • Forms are completed for those accounts in good standing. Outstanding balances need to be paid prior to forms being filled out.
  • Many forms require a current examination prior to being completed. If this is the case, you will be notified and asked to schedule an office visit. You will not be charged for both the office visit and the form completion. Please understand that your insurance may not cover an office visit for form completion and if they do not, the charge is your responsibility.
  • If you have seen a provider within the past 3 months, then you may leave the forms and a provider will complete them and return them to you.
  • All forms and letters require seven (7) business days to complete.
  • Fees for letters requested on SPC letterhead for medical necessity (including but not limited to):
    • Jury duty: $25
    • All other letters requested based on content: $50-$100
  • Fees for form completion (including, but not limited to, disability, FMLA, DMV, FL2, DME, biometric screening, insurance review, etc.):
    • 1 page: $25
    • 2-5 pages: $35
    • 6-10 pages: $50
    • 10+ pages: $100
    • Fees for handicapped tags/parking permits: $25 (Please note SPC will consider a handicapped tag ONLY if the patient is wheelchair-bound, on crutches or a walker or is on continuous oxygen therapy)