• FMLA / DISABILITY FORM REQUEST

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    • There is a fee for each form that needs to be completed.
    • The form is typically completed within 7-10 business days from date of payment.
    • Please ensure that you have only completed the “patient” portion of your form. We are unable to submit forms in which the “physician/provider” portions have been completed (even in part) by someone other than an Alliance Ob-Gyn staff member.
    • Forms 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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