Submitting FMLA, Disability, Work Accommodations, and other Forms
Millard-Henry Clinic has partnered with Verisma to provide Medical Form Completion services for FMLA, Disability, Work Accommodations, and other Forms.
This partnership helps us provide fast and accurate completion services and ensure your peace of mind for medical and/or disability leave.
- 3 business days for expedited turn-around time, and 7 business days for standard (Expedited turn-around is an additional $20 per form.)
- Verisma verifies accuracy by using information from your chart and regular quality checks.
- Verisma guarantees your information is distributed safely & securely with state-of-the-art distribution software.
- Pre-payment is required before your Form can be processed. Note there are no Form fees for Workers' Compensation Forms or patients with Medicaid coverage. Coverage will be verified before completing your Form.
Instructions for submitting your form
- Click the 'Submit a Form' button below.
- Read all instructions and agreements.
- Accept all agreements.
- Enter required information.
- Upload Photo ID, Blank Form, and accompanying documentation if required.
- Pay per Form fee as noted: Standard Disability, FMLA, or other Form is $40; Standard Continuation or Form update is $25.
- Submit the Form for completion.
If your Form requires lab work, diagnostic imaging, or additional testing, we encourage you to have this completed as soon as possibility to avoid any delays in your Form being completed.