Mental Health Forms & Letters

Forms & Letters

Dr. Goldberg & Associates understands that patients may occasionally need a clinician to complete a form, write a letter, or prepare a professional evaluation for an employer, school, housing provider, government agency, insurance company, attorney, or another organization.

These requests require time outside of scheduled appointments. They may involve reviewing your medical record, considering your current symptoms and functioning, consulting applicable clinical guidelines, and preparing documentation that accurately reflects your treatment.

Our Documentation Team coordinates all forms and letter requests to help ensure that the appropriate authorizations, cost approvals, payments, and delivery instructions are completed.

Email us at [email protected]

Request For Documentation Form (RFDC)(opens in new tab)

Types of Forms and Letters

The Documentation Team can help coordinate several types of requests. Completion is subject to your clinician’s professional judgment, willingness, and ability to provide the requested information.

General Forms and Letters

General documentation may include:

  • Treatment verification letters
  • Diagnosis verification letters
  • Return-to-work or return-to-school letters
  • Treatment summaries
  • Letters confirming appointment attendance
  • Forms related to a patient’s symptoms, functioning, or treatment
  • Other requests requiring information or professional input from a clinician

Some requests may be completed quickly, while others require a more detailed review of your treatment history. The amount of time and cost will depend on the complexity of the request.

FMLA, Disability Forms, School/Work Accommodation Forms

Family and Medical Leave Act forms and disability documentation typically require more detailed clinical information than a general letter.

Your clinician may be asked to describe:

  • Your diagnosis or symptoms
  • How your condition affects your daily functioning
  • Relevant treatment information
  • The anticipated length or frequency of leave
  • Work-related restrictions or accommodations
  • Whether intermittent or continuous leave is clinically supported

Submitting an FMLA or disability form does not guarantee that your clinician will be able to support every requested accommodation, restriction, or leave period. Your clinician must answer the questions based on their clinical knowledge, professional judgment, and the information available in your record.

Emotional Support Animal Letters

An Emotional Support Animal letter is a clinical document stating that a patient has a qualifying mental health condition and that the presence of an animal may help reduce symptoms or support functioning.

Before agreeing to write an ESA letter, a clinician may need to evaluate:

  • The patient’s diagnosis and symptoms
  • The extent to which symptoms affect daily functioning
  • The relationship between the animal and the patient’s mental health needs
  • Whether the clinician has enough information to provide a professional opinion
  • Whether the requested letter is within the clinician’s scope of practice

Clinicians are not automatically required to write ESA letters. Your clinician may decline the request if they do not believe they have enough clinical information, cannot support the request, or do not provide this type of documentation.

An ESA letter is also different from documentation for a trained service animal.

Substance Use Evaluations

A Substance Use Evaluation is a formal assessment intended to help clarify a person’s history of alcohol or drug use, current concerns, level of functioning, and treatment recommendations.

These evaluations may be requested by:

  • Courts or attorneys
  • Employers
  • Professional licensing boards
  • Schools
  • Treatment programs
  • Probation or other monitoring agencies
  • Patients seeking diagnostic clarification or treatment recommendations

The number of evaluation appointments varies depending on the provider, the reason for the evaluation, and the information needed. Evaluation sessions are billed separately from the written report.

There is a $400 fee for the Substance Use Evaluation report. Appointment charges are separate and depend on the provider’s standard session rate and the number of sessions required.

Before scheduling, please provide the reason for the evaluation, the referring person or organization, any required deadline, and instructions describing what the report must address.

The Three-Visit Guideline

As a general guideline, patients should complete at least three appointments with their clinician before requesting forms or letters.

This guideline gives your clinician an opportunity to learn about your:

  • Symptoms and diagnosis
  • Treatment history
  • Current functioning
  • Response to treatment
  • Relevant personal, school, or employment circumstances
  • Documentation needs

A clinician often cannot provide a responsible professional opinion after only one appointment. Forms and letters may ask the clinician to make specific statements about your condition, limitations, accommodations, prognosis, or ability to perform certain responsibilities. The clinician must have enough information to answer these questions accurately.

The three-visit guideline may differ based on the clinician’s professional judgment and preferences. Some clinicians may require more than three appointments, while another provider may determine that a request can be considered sooner.

Completing three appointments does not guarantee that a request will be approved or completed.

Please Discuss the Request With Your Clinician

Before submitting a forms or letters request, we encourage you to speak directly with your clinician during an appointment.

Explain:

  • What document you need
  • Why it is being requested
  • Who will receive it
  • What information the document must include
  • When it is due
  • Whether the requesting organization has provided a specific form

This conversation allows your clinician to tell you whether they are willing and clinically able to complete the request.

Clinicians are not required to complete forms, write letters, recommend accommodations, certify leave, or provide a particular professional opinion. A clinician may decline when:

  • They do not have enough information about your condition
  • The request is outside their role or scope of practice
  • The requested statements are not supported by their clinical findings
  • The form requires an evaluation they have not performed
  • They do not provide that type of documentation
  • A specialized or independent evaluation is more appropriate
  • Completing the request could create a conflict of interest

The Documentation Team coordinates the administrative process, but it cannot require a clinician to accept a request or determine what the clinician writes.

How to Request the Form/Letter

In order to start the process, the Request for Documentation Completion Form (RFDC) must be completed. You can complete the document by using the form below. Please make sure to complete the Release of Information with the recipient's information if it is being released to someone other than yourself.

Request For Documentation Form (RFDC)(opens in new tab)

Forms and Letters Fees

Documentation work occurs outside of your scheduled clinical appointments and is not included in the cost of a therapy, psychiatry, or testing appointment.

General Forms & Letters Documentation

General forms and letters are typically billed according to the amount of time required to complete them. The rate for completing the documentation is billed at your provider's intake rate.

Licensed Clinical Social Worker/MSW | $3.33 per minute, or $200 per hour

Licensed Professional Counselor/M.Ed | $3.33 per minute, or $200 per hour

Psychologist (Psy.D/PhD) | $4.16 per minute, or $250 per hour

Psychiatrist (MD) & Nurse Practitioners (NP) | $5.83 per minute or $350 per hour

The final cost depends on the time your clinician spends reviewing your record, completing the form, writing the letter, consulting with the Documentation Team, and making any necessary revisions. These costs cannot be billed to insurance.

FMLA, Disability, and Similar Formal Documentation

More detailed requests, including FMLA and disability paperwork, generally cost:

$250–$350 for the first hour regardless of how long the documentation costs.

Additional time is billed at the applicable per-minute rate when the request requires more than one hour.

ESA Letters

ESA documentation generally costs:

$250–$350 for the first hour regardless of how long the documentation costs

Additional time may be billed at the applicable per-minute rate when the request requires more than one hour.

Substance Use Evaluations

The written Substance Use Evaluation report costs:

$400

Evaluation appointments are billed separately.

Quotes, Deposits, and Final Payment

After receiving your request, the Documentation Team will ask your clinician whether they are willing to complete it and how much time they expect it to take.

You will then receive a quote for review and approval.

For most requests:

  1. You approve the quoted cost.
  2. A deposit equal to approximately 50% of the quote is collected.
  3. Your clinician is notified that work may begin.
  4. The remaining balance is charged after the document is completed.
  5. The document is released after the balance has been paid.

The quote is an estimate rather than a guaranteed final total. The cost may be higher or lower depending on the actual time required.

Your clinician should not begin working on the request until the Documentation Team confirms that the required forms and deposit have been received.

Expedited Requests

Requests needed in fewer than five business days may be considered expedited.

When expedited completion is available, an additional fee of 25% of the total documentation cost may apply.

Expedited processing:

  • Must be requested in advance
  • Requires your approval of the additional cost
  • Depends on your clinician’s availability
  • Is not guaranteed
  • Does not override the need for appropriate clinical review

Please submit requests as early as possible. A deadline provided by an employer, school, court, insurer, or another organization does not guarantee that your clinician can complete the documentation by that date.

Release of Information Requirements

A Release of Information form is required when the completed form or letter will be sent to anyone other than you.

This includes sending documentation to:

  • An employer or human resources department
  • A school or university
  • A disability or insurance company
  • An attorney
  • A court
  • A housing provider or property manager
  • A government agency
  • Another medical or mental health provider
  • A family member or other designated person

The Release of Information form gives Dr. Goldberg & Associates permission to communicate with and send the document to the person or organization you identify.

Please provide complete and accurate contact information. We can only release the document to the individual or organization authorized on your form.

When the completed document will be released directly to you, the Documentation Team will advise you whether any additional authorization is required.

Forms and Letters Process

1. Speak With Your Clinician

Discuss the request during an appointment and ask whether your clinician is willing to complete it.

2. Contact the Documentation Team and Complete the Required Forms

Provide the type of form or letter requested, the deadline, delivery instructions, and any documents supplied by the requesting organization.

The Documentation Team may send forms through IntakeQ, including:

Please check your spam or junk folder if you do not see the forms in your inbox.

4. Clinician Review

The Documentation Team contacts your clinician to confirm whether they are willing to complete the request. The clinician provides an estimated completion timeframe and an estimate of the time required.

5. Quote and Deposit

You receive a quote for approval. After you approve the quote and pay the required deposit, the Documentation Team tells the clinician that work may begin.

6. Document Completion

Your clinician reviews the relevant information and prepares the form, letter, or report.

Your clinician is responsible for the clinical content. The Documentation Team cannot direct the clinician to include a particular diagnosis, recommendation, restriction, accommodation, or professional opinion.

7. Final Payment and Release

After the completed document is returned to the Documentation Team, any remaining balance is processed.

The document is then securely sent to you or to the person or organization identified on your authorization.

Why Forms and Letters Take Time

Forms and letters require more than adding a signature to a document. Depending on the request, your clinician may need to:

  • Review multiple appointments and portions of your medical record
  • Confirm diagnoses and treatment history
  • Evaluate current symptoms and functioning
  • Answer detailed questions about limitations or accommodations
  • Consider whether a requested recommendation is clinically appropriate
  • Write a treatment summary or supporting explanation
  • Coordinate with the Documentation Team
  • Revise the document when required information is missing
  • Ensure that statements are accurate and professionally supportable

Requests are handled in the order received. Completion time also depends on the clinician’s appointment schedule, availability, the complexity of the request, and the amount of documentation involved.

Important Information About Payment

Forms, letters, reports, records fees, and other administrative services are generally separate from billable clinical treatment.

HSA and FSA cards cannot be used for records release fees, document completion fees, legal fees, or other administrative and documentation-related charges. A standard credit card, debit card, or another approved payment method is required.

Insurance generally does not cover time spent completing administrative forms or writing letters outside of an appointment.

Frequently Asked Questions

Does completing three appointments guarantee that my clinician will write the letter?

No. Three appointments are a general minimum guideline intended to give the clinician time to become familiar with you and your needs. Your clinician may require additional appointments or may decline the request based on their professional judgment.

Can the Documentation Team require my clinician to complete a form?

No. The Documentation Team coordinates consent, payment, tracking, and delivery. It cannot require a clinician to complete a request or determine the clinical information included in the document.

Can my clinician complete the form during an appointment?

In some circumstances, your clinician may agree to address a form during a scheduled session. Please discuss this directly with them. The clinician will determine whether the request can reasonably be completed during the appointment or requires additional work outside of the session.

Will my clinician write exactly what I ask them to write?

Your clinician will consider the purpose of the request and your concerns, but they must provide their own accurate clinical opinion. They cannot include statements, diagnoses, restrictions, or recommendations that they cannot professionally support. If there is particular wording you need included, please let them know that so they can evaluate whether they can accommodate the request.

What happens if my clinician declines the request?

The Documentation Team will inform you that the clinician is unable to complete it. Depending on the type of documentation, you may need to request a specialized evaluation or contact another qualified professional.

Is a Release of Information form always required?

A Release of Information form is required when the document will be sent to a third party. The authorization must identify the specific person or organization permitted to receive the information.

Can a form be sent somewhere that is not listed on my authorization?

No. For privacy and security reasons, documentation can only be sent to the recipient you authorized.

How much will my request cost?

The cost depends on the type and complexity of the documentation and how long it takes your clinician to complete. You will receive an estimated quote before work begins.

How long will the process take?

Timing varies based on clinician availability, the type of request, the amount of information that must be reviewed, and whether all required forms and payments have been received. Submit your request well before any external deadline.

Contact the Documentation Team

All forms and letters requests are coordinated by the Dr. Goldberg & Associates Documentation Team.

Email: [email protected]

  • Please avoid including detailed or highly sensitive clinical information in the email subject line.

The Documentation Team primarily communicates through email and generally responds within 24–48 business hours. This response timeframe applies to email communication and does not represent the time required to complete your documentation request.

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