MEDICAL GROUP
Monday-Friday 8 - 5 PM
909-596-4879


URGENT CARE
Monday-Friday 10 - 10PM
Sat/Sun 10 - 6PM
909-971-4808

Form Fees 2

FORM FEES

Please complete the consent form below. We will make every effort possible to get your form to you within 5-7 days. Please make payment before you request the form.

Service Cost
Jury Duty $20
Physical Form $25
FMLA Paperwork $50
Costco Paperwork $50
Physician’s Report $30
School Forms $25
Handicap Parking Permit | Placard $25
Short Term Disability $50
Permanent Disability $75
Employment Development Department (EDD) $50

Consent Form

Consent for Non-Covered Form Fees

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