Form Fee
Effective January 1, 2026
Form Processing Fees:
$25.00 (please allow up to 5 business days for processing time)
- Payment must be made before the form is completed.
- Please note that the provider may request an office visit to evaluate you/your child before completing these forms if you haven’t been seen in the last 6 months
Note: No fee will apply if the paperwork is given to the provider/nursing staff during a scheduled appointment. However, forms may not be completed and returned on the same day due to high patient volume and adequate time needed to ensure forms are accurate. Please allow up to 5 business days for form completion.