Disability and Family and Medical Leave (FMLA)
Instructions for Disability and FMLA
The Family and Medical Leave Act (FMLA) provides certain employees with up to 12 weeks of unpaid, job-protected leave per year. It also requires that their group health benefits be maintained during the leave. At Delaware Valley OBGYN & Infertility Group, we understand your need to have FMLA or other disability forms completed.
To complete disability or FMLA forms for time off from work due to pregnancy or surgery, please make sure you fill out all of your paperwork in the sections marked ‘Employee’ and sign all employee signature areas before bringing the forms to the office. In addition to the forms provided by your employer, you will also need to print and complete our Disability Forms Request.
Please allow up to 7 to 10 business days for submissions to be completed.
Fee: (No Exceptions):
- $10 Per Set of Forms If Picked Up in Person
- $12 If Faxed
Forms can be Faxed to: (973) 852-1743
Delivered to the office: during normal business hours.
If you have any questions, please call (609) 896-0777 ext. 245
PLEASE NOTE – We cannot take responsibility for forms lost in the mail. It is your responsibility to provide the completed forms to your insurance company or employers. Please do not hand these forms to our physicians or nurses, as they see numerous patients a day and forms can be misplaced.