Third Party Insurance Forms

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(Disability, FMLA, CT Paid Leave, State of CT, Employer forms, etc)

 

As a convenience to our patients, our office is more than happy to complete Third Party Insurance Forms of all types such as your Family Medical Leave Act (FMLA) or Short-Term Disability paperwork for you, at no charge.

Please:

  • Complete all patient areas on your forms.  In addition, compliance requires that no form be completed without a dated signature from the patient.
  • Allow 14 days for completion of the forms. We cannot complete forms at the time of visit
  • Leave all sections to be completed by our healthcare provider blank. If you improperly complete a form, it may cause delays and / or we may request a new form from you.
  • Let us know if you would like your form faxed, e-mailed or if you will pick up in person.
  • Upload your completed form below.  Note, we can not accept pictures of a document.