Disability & FMLA Forms

The following is our process for completing Disability and FMLA forms. Should you have any questions regarding your forms, please call our Medical Records Department at 252-757-2663.


  • Your form(s) and a signed Request for Medical Records Form, may be delivered to the office or faxed to 252-758-7484.
  • Our fee to complete each form is $20.00. This is payable by check, cash or credit card. This fee must be paid prior to the completion of the form either at the time of delivery or if faxed, by a telephone credit card transaction.
  • The patient information portion of the form must be completed prior to processing.
  • Once we receive your form(s) and your signed authorization to release your medical information, please allow 5 to 7 business days for processing the request.
  • All completed forms will be mailed or faxed to the disability carrier/employer as indicated by the patient or may be picked up at our office.
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