Form Fees

Neurological Specialist puts emphasis on transparency of potential costs related with care that will be charged in special circumstances depending on patient’s extra needs and requests.

 

Towards that end we have compiled a list of representative costs for common types of forms and letters. This list is not exhaustive and may not represent to full gamut of potential forms, letters or other requests. We reserve the right to determine the cost of any unlisted form or letter that may be requested of us.

 

Simple standard letters/forms    $10 per letter

 

Straight forward return to work letter/form.

Handicap parking forms.

Attestation that patient is seen in practice letter.

Jury duty exemption letter.

 

Medium level letters/forms   $20 per letter/form

 

One page DMV form releasing patient to drive.

Connecticut FMLA form (standard).

Release to fly.

 

Complex letters/forms requiring review of the full chart   $50 per letter/form

 

Short-term disability forms/letters (for each set of forms).

ADD/ADHD accommodation letters.

Housing accommodations for college dorms.

Summary of patient’s history for any reason (letter or form).

Insurance related letters.

Any form exceeding 3 pages to be filled.

 

Highest complexity  $75

 

Long term disability forms or letters (for each set).

Patient Legal capacity letters/forms.

Any form exceeding 5 pages to be filled.

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