Please allow adequate processing time for all forms up to 20 business days.

All FMLA and disability forms must be provided by your employer. Please contact your Human Resources Department to obtain the required paperwork.

It is the patient’s responsibility to confirm eligibility and understand their employer’s policies and procedures regarding medical leave and short-term disability benefits. Submit by office drop-off or email: [email protected]

Our office does not release information over the phone to employers or third parties.
All requests must be submitted in writing. Fax requests: (713) 467-9709

Form Completion Fees

$30 fee for the first form completed additional forms will incur additional fees. Updates may be requested; additional charges may apply. Completed documents will not be sent to third parties. Forms must be picked up by the patient or an authorized representative.

Short-Term Disability Forms

Short-term disability forms may be completed by our office when medically necessary. Medical disability requires documentation of a medical diagnosis that prevents you from performing your job duties.
Pregnancy alone is not considered a medical diagnosis for disability purposes.

  • If short term disability is denied, you may appeal through your insurance or disability provider by submitting additional documentation. Our office does not file appeals.
  • If disability leave is not approved by your provider, please contact your employer to discuss alternative leave options.
  • Forms accepted no earlier than 30 weeks of gestation (If a third party requires forms after delivery, please submit after delivery).
  • Gynecology forms (surgical related) must be submitted 30 days prior to scheduled surgery.

Family and Medical Leave Act (FMLA)
FMLA forms may be completed by our office based on the standard recovery period for routine care.

  • Standard maternity recovery leave: Up to 8 weeks
  • Forms accepted no earlier than 30 weeks of gestation in pregnancy.
  • Surgical leave requests vary based on medical necessity and will be discussed with your provider.

Return-to-Work / Fitness-for-Duty Forms

  • Return-to-Work or Fitness-for-Duty forms must be brought to your postpartum or post-operative appointment. Forms cannot be completed prior to your follow-up visit.