FMLA/Disability paperwork is complex and takes time away from our ability to care for you when you’re in the office or during phone consultations. We recognize that accurate and timely completion of these complicated forms is critical to you receiving your FMLA benefits.

Please ensure your name is on all paperwork—the FMLA/Disability Authorization form(s) AND your company/organization’s paperwork—especially when submitting paperwork on behalf of your partner or family member. 

1) To initiate your FMLA/Disability request(s), complete either the:

2) Deliver the completed authorization/release and the blank FMLA and/or Disability form(s) to be completed to your VWC provider’s office, or you may fax them to 804.282.8678.

3) A fee of $30 per FMLA & Disability submission is required to initiate the data collection process and complete the necessary paperwork. You may pay the required fee(s) in the office when you drop off your paperwork, online through your myPrivia patient portal, or by phone 804.282.1095.

4) Once payment is made in full and forms received, your paperwork will be completed within five (5) business days and sent to the recipient designated on your FMLA/Disability Authorization Form(s).

If you have any questions, email