*Required fields are marked with an asterisk.

Medical Records Forms

Loading Please wait

Save time and postage--submit your forms electronically

Select the form you need from the list on the right side of your screen. Download, complete, print, sign, scan and attach it below. 

FMLA/Disability Paperwork:
We are partnering with Sharecare Health Data Services to better care for you.
FMLA/Disability Paperwork is complex and takes time away from our ability to care for you when you're in the office or during phone consultations. 
Effective December 4, 2017, all FMLA/Disablity forms will be processed by Sharecare HDS. There is a $30 fee to complete all of the necessary paperwork. 

Please complete, sign and date the FMLA/Disability Authorization form available on this page. You may submit it together with the FMLA/Disablity paperwork here.
Sharecare will contact you either by email or phone within 48 hours to accept your $30 payment. 
Once payment is received, you paperwork will be completed in 5-7 business days and sent to the recipient you designated on your FMLA/Disablity Authorization Form Request. 

Note: We recommend using Firefox Firefox (Windows, Mac, Linux) or Google Chrome Google Chrome (Windows, Mac, Linux) browsers.  Or, you may fax your document to 804-282-2601.



Please note: "Submit Documents Complete" and a success message will display after clicking the send button if your message is submitted successfully. Please re-submit your message if this does not display.Messages sent after 4PM Monday - Friday, on weekends or holidays may not be processed until the following business day. If this is an emergency or if you think you are in labor, do not use this page. Please call our office at 804-288-4084.

In the event one of these online services isn't working properly, please call us at (804) 288-4084, Monday-Friday 8:00AM-4:30PM. To protect your privacy and ensure your health, we cannot accept information meant for this portion of the site through email.

Please enter a custom answer