• FMLA / DISABILITY FORM REQUEST

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    • There is a fee for each form that needs to be completed .
    • The form is typica lly completed within 7 - 10 business days from date of p ayment .
    • Please ensure that you have only completed the “patient” portion of your form. W e are unable to submit forms in which the “physician/provider” portions have been completed (even in part) by so meone other than an Alliance Ob - Gyn staff member.
    • Fo rms are completed for medically indicated time off work ONLY. Any additional time that you are eligible for under FMLA must be coordinated by you and your employer.
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