Due to the extremely high volume of requests for the production of forms and letters and its impact on our staff on a daily basis, effective May 1, 2006, we are instituting a $10.00 charge per form or letter.
There will be no charge for forms completed when a patient is seen for an office visit or regular checkup, for forms that a family has prepared that only require the physician¡¦s signature, or for prescriptions that are for previously prescribed medications (refill prescriptions). Forms for siblings not examined will incur the $10.00 charge per form.
Listed below are examples of the types of forms and letters that are subject to the $10.00 charge:
Letters:
„X Requests such as special diets, extra school books for home use, etc.
„X Special needs placement
„X Appeals/medical necessity letters for insurance companies
„X Travel-related issues
„X Adoption
„X Recommendations for private school admission
„X Complicated insurance claim justifications
Payment is required in advance of preparation of the requested form or letter.
