We like to keep things simple and transparent. Here’s what you need to know about documentation requests, administrative fees, and a few of the behind-the-scenes details of working with Revive.
Already know what you need? Make a request ↓We’re happy to provide records and additional documentation when clinically appropriate and within your therapist’s scope of practice. Because these requests require time outside of your regularly scheduled sessions, administrative fees may apply.
Copies of medical records and treatment documentation are billed at $7 per page.
This includes records requested by clients or authorized third parties such as attorneys, insurance carriers, disability companies, employers, or schools.
Payment is required before records are released.
Paperwork, letters, and other documentation requiring your therapist’s time outside of session are billed at a flat rate of $150 per request.
This may include FMLA paperwork, ESA letters, disability or leave paperwork, work or school forms, housing documentation, and other provider-completed letters.
Payment is required before the request is reviewed or completed.
To request forms, letters, or other special documentation, the following requirements must be met:
You have completed at least 5 sessions with a Revive provider.
You are actively engaged in treatment at the time of your request.
Meeting these requirements does not guarantee that a request can be completed. Your therapist will review each request individually and provide documentation only when it is clinically appropriate and supported by your treatment.
Send your documentation request to our office with your contact information, the type of request, and detailed information about exactly what you need.
If you have a form that needs to be completed by your provider, attach a blank copy of the form to your email request.
Our office will review your request and follow up regarding the applicable fee, any authorization that may be required, and next steps. Processing begins once payment and required information are received.
Revive Wellness Center reserves the right to decline requests for documentation that a provider determines are outside their scope, cannot be clinically supported, or would otherwise be inappropriate based on the client’s treatment history and clinical presentation.
Send us an email with the details of your request and we’ll take it from there. If you have paperwork that needs to be completed by your provider, simply attach a blank copy to your email.
01. Your full name
02. Phone number
03. Email address
04. Type of request — ESA, FMLA, Medical Records, or other documentation
05. Detailed information about what you need, where the documentation should be sent, and when it is needed
06. Attach any forms that need to be completed by your provider
Clicking the button will open a new email addressed to contact@revivewellnesscenter.com with a documentation request template already included for you.
