Instructions for Submitting Your Form

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Instructions

• This site is for patients or their caregivers who need a form completed to apply for disability benefits or employer leave.
• ONLY ONE FORM is permitted per request. For EACH type of form you need completed by the clinic, you MUST submit a new and separate request on this site. For each request, upload ONE form only, pay for it (if applicable), and submit it online. If you have more than one form to be processed, you must submit and pay for each form separately. For example, if you need 3 different types of forms - then you must submit 3 separate, independent online submissions.
• IF YOU UPLOAD MORE THAN ONE FORM PER ONLINE SUBMISSION THEN YOUR FORM SUBMISSION WILL BE REJECTED.
• Your form will be completed within 7 business days of receipt.
• Pre-payment is required before your form can be processed.
• No refunds will be given unless the form cannot be completed by All Star Orthopaedics.
• The processing time begins once we have received all necessary items: prepayment, a Release of Information authorization, your ID, and the form.
• Once completed, your form will be made available online for you to save, print, or email as needed. You may also ask for your form to be faxed directly to a third party (such as an insurance company or employer) or to yourself.
• You will need the following:
  1. A valid driver's license or other valid state-issued ID.
  2. A picture or PDF of your form ready to be uploaded*
  3. A credit/debit card to make payment
  4. (Optional) The contact information of the recipient, if you want your completed form sent to a third party (e.g. an employer or insurance company).

Please have these items handy before you start!

* You should fill out any patient/caregiver sections of your form before submitting it to us.

To keep you up-to-date, you will receive two text alerts - one to confirm that your request is in process and one to let you know that your request has been completed.

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