top of page

Forms Completion Policy

At QCC, the only documentation required by law and included in your office visit is your medical note. Any additional form requests such as for school, camp, FMLA, disability, insurance, or employment require additional time and cannot be billed to your insurance.

Because these forms require a provider’s review and signature, they must be completed carefully and accurately, and often require clinical judgment beyond routine care. Therefore, our office charges a fee for form completion.

Fees:

  • Flat processing fee: $25

  • Plus: $5 per page

  • Maximum total charge per form: $50

  • We will never charge more than $50 for any single form, regardless of the number of pages.

We aim to complete all forms within 3 business days after payment is received.

How to Request:

Please email your form to frontdesk@qcccare.com. Once received, we will:

  1. Review the form.

  2. Send you an invoice.

  3. Complete the form within 3 business days of payment.

If the form was sent directly to us by an outside organization, we will notify you of any required fees and may ask for a signed Authorization to Release Medical Records.

​

To avoid charges, you may request that the recipient accept your most recent office note instead of a completed form. If you’d like us to send your note, email a signed authorization to frontdesk@qcccare.com.

 

Note: Some forms may require an updated exam or office visit. If this is necessary, we will ask you to schedule an appointment and the form will be completed at no extra charge as part of your visit.

For questions or support, contact frontdesk@qcccare.com.

bottom of page