Midwest Disability & FMLA Forms

For Patients of: Southside OB/GYN, OB/GYN of Indiana, Seven Hills Women’s Health Center, or Lexington Women’s Health

Forms are $30 for the first form and $15 for each additional form turned in at the same time. After payment is received, Disability/FMLA forms are completed and sent to the requestor within three business days.

Turn in your form(s) to be completed via the following options:

• Email: A PDF of the form can be sent to [email protected]
• Fax: 888.972.2476
• Mail: MediCopy Attn: Form Completion Dept. 8 City Blvd. Suite 400, Nashville, TN 37209
• In-Person: Drop the blank Disability or FMLA form off at your doctor’s office.

Please include an intake form with your paperwork.

• Authorization for the Release of Disability/FMLA form (Online)
• Authorization for the Release of DIsability/FMLA form (Paper)

Learn more about MediCopy’s Form Completion service

If you have any questions, please contact MediCopy:

Online Chat: MediCopy.net | Phone: 866-587-6274 | Email: [email protected]