Medical Form Fees
Effective Sept 18, 2008, these fees apply for processing the following list of forms:
| FORM TYPE | FEE |
|---|---|
| School Forms | $5.00 |
| Medication Action Plans | $5.00 |
| IHSAA Forms | $5.00 |
| College Health Forms | $5.00 |
| Camp Forms for Special Needs | $5.00 |
| FMLA Authorization Forms | $20.00 |
| Disability Authorization Forms (other than those paid for by the state of Indiana) |
$14.00 |
| Adoption Forms | $25.00 |
Fees do not include office visits.
Payment is required at the time of request.
Insurance companies do not provide a benefit for completing medical forms, so we do require payment when the service is requested.
EXCEPTION: Some plans do cover services for ADHD, so charges to complete these forms will be submitted to the insurance company for payment consideration. If the insurance company does make a payment it should be sent directly to the insured. If the insurance company sends payment to Northpoint Pediatrics, we will promptly send you a refund.
