Medical Records, Forms, and Letters Consent Form 

We are happy to assist you with any medical documentation you may need. On the date of service, visit summaries and school/work excuses are always available at no charge. All patients can access their medical records for FREE in our patient portal; the portal also allows you to print and share your record for FREE. However, requests for medical records that require submission outside of the patient portal will incur a retrieval fee. Please note that a request for a complete medical record does not include psychotherapy notes. Psychotherapy notes are protected under federal and state privacy laws to preserve the confidentiality of the therapeutic process; therefore, they cannot be released as part of a standard medical record request.

Any other letters or documentation are available for the fees below:

Medical Records Retrieval:

• Search Fee: $25.88

• Pages 1 - 20: $0.97 per page

• Pages 21 - 100: $ 0.83 per page

• Pages 101+: $0.66 per page

• Certification Fee: $9.70

General Forms:

• $35 for first page, $15 for each additional page

Examples include:

• Adoption Forms

• Assisted Living Form

• Diagnosis Letters ($15)

• Disability Determination

• Home Health Forms

• Insurance Requests

• Jury Exemptions

• Letters to Attorneys, Insurance Companies, Employers, Schools, Airlines, Travel Agents, etc.

• Nursing Home Entrance

• Parking Affidavit/ Handicap Form

• Patient Transportation (MARTA)

• Pre-Operative Forms

• Workers Compensation Requests

• FMLA Evaluation Packet

• Fee: $350

• Includes initial disability evaluation report, initial FMLA packet, and initial Short Term Disability packet

Complex Documents

• Fee: $500+

For example:

• VA packet

• Attorney’s Packet

We will mail or fax the requested records within 14-21 business days. Requests can be expedited and handled within five business days for a fee of $50 in addition to the base fee. We do understand the urgency of your requests; however, requests are processed in the order they are received. Thank you for your patience and understanding.