Medical Letters & Records

Certain administrative services that fall outside of standard medical care will not be covered by insurance and will incur a self–pay fee to cover the time and resources required to prepare these documents. This includes patient medical records and letters for work or school leave of absences, FMLA/Disability extended forms or paperwork, and ESA Letters; letters supporting an emotional support animal in specific settings, including housing and travel.

Medical Records 

Third Party and Personal Use: For medical records sent to you or a third-party provider such as another clinician, attorney, or family member, we charge a $20 handling fee, .37 cents per page for the first 50 pages, .18 cents for each additional page, and any shipping fees if they are mailed. Please fill out the medical record release form here and send it to billing@washncgroup.com.

Letters

Some of our mental health therapists and psychiatry providers will write letters on your behalf. Most will require 3 months of treatment and/or 6 telehealth or office visits for Family Medical Leave Act (FMLA) and Emotional Support Animal (ESA) letters. 

1 Page Letter: $100 
(e.g. work excuse, return to work or school, other 1-page letters) 
2 Page Detailed or Custom Letter $200 
(e.g., letters for school, travel, or legal purposes ) 
FMLA/Disability extended forms or paperwork: $300-$500 
(forms for leaves of absence related to the Family Medical Leave Act ) 
ESA Letters: $300-$500 
Letters supporting an emotional support animal in specific settings (housing, travel)  

Payment Policy for Medical Records and Letters

All administrative fees must be paid prior to the release of a letter or form. Fees are non-refundable once the document has been prepared.

If you have any questions about whether a specific request will incur a fee, please contact our office before submitting your request.