Effective October 1, 2016, Dothan Pediatric Subspecialty Clinic will charge for the completion of forms when not completed at the time of service.
As an alternative you can use your patient portal account to request forms at NO CHARGE. If you do not have a patient portal account, please call us at 334.699.3733, ext. 2699.
| Form |
Cost |
Time for Completion |
|
FMLA
|
$20
|
10 days
|
|
School Medication Forms
|
$10
|
10 days
|
|
School Excuses for Past Visits
|
$10
|
10 days
|
|
Letters
|
$25
|
10 days
|
|
Miscellaneous Forms
|
$10
|
10 days
|
|
Patient Profile for Social Security
|
$5
|
1 day
|
|
LIHEAP - Power Assistance
|
$5
|
1 day
|
An additional $20 will be charged for forms completed the same day (Patient Profile and LIHEAP not applicable).
View Medical Release Form
