PATIENT INSTRUCTIONS FOR FMLA/DISABILITY
REQUESTS
MidJersey Orthopaedics has partnered with HealthMark Group to ensure the accurate
and timely completion of your FMLA and/or Disability forms.
A signed and completed authorization form is required from each patient.
Each form requested for completion will require a $35 fee to be paid directly to
HealthMark Group. HealthMark Group will complete the forms upon receipt of the
requested forms and a valid authorization. The estimated turnaround time will be 24-
72 hours. If an email is provided, you will receive a response directly from HealthMark
Group notifying you of the prepayment invoice. After payment, the completed forms
may be downloaded directly through HealthMark Group’s website, or provided
directly to you through an agreed to delivery method (i.e. secure email, mail, etc.)
If you would like to inquire on the status of your forms or have any additional
questions, please call 972-895-2138 or email [email protected]
P.O. Box 224688
Dallas, Texas 75222
800.659.4035 – Toll Free
800.833.5935 - Fax
