Fees
NON-MEDICAL SERVICE OFFICE FEE SCHEDULE (Please note that if an office visit is scheduled or if you bring paperwork with you to your visit, there is no additional fee associated to fill out paperwork.) Please note that if a request is more complex, there may be an additional fee.*
| Forms for camps, schools, employers, license renewals (not including CDL), extended care facilities, VA Hospitals and other forms not mentioned i.e. FMLA). | $25.00-$50.00 |
| Writing letters or reports for travel reimbursement due to illness, doctor’s notes for missed work/school days, return to work notes after illness, excuse from jury duty, medical summaries for travel or other agencies | $25.00 |
| Notarizing documents | $25.00 |
| Short Term Disability/ Family Medical Leave | $25.00 |
| Adoption forms | $50.00 |
| Copy of medical record file | $0.65 per page |
| Durable medical goods paperwork (excluding motorized wheelchair) | $15.00 |
| Durable medical goods paperwork for motorized-wheelchairs | $50.00 |
| Handicap Sticker New Requests and Renewals | $10.00 |
| Work health forms | $10.00 |
|
This requires a physical examination per State of Connecticut regulations that is not billable to your regular insurance.
Please see Commerical Driver License for a more in depth explanation.
|
$250.00
|
Office
1300 Post Road
Suite #202
Fairfield, CT 06824 - 6038
Suite #202
Fairfield, CT 06824 - 6038
Call
(203) 255-8827
Hours
Monday:
9:00am - 5:00pm
Tuesday:
9:00am - 5:00pm
Wednesday:
9:00am - 5:00pm
Thursday:
9:00am - 5:00pm
Friday:
9:00am - 5:00pm
Sat/Sun:
on call physician available for emergencies
Call Us: (203) 255-8827 Fax: (203) 259-4610
1300 Post Road #222 Fairfield, CT