• NNG
  • ABOUT US
  • PROVIDERS
  • HEADACHE TYPES
  • SERVICES
    • Botox® for Migraines
    • Occipital Nerve Block
    • Sphenopalatine Ganglion Block
    • Supraorbital Nerve Block
    • Trigger Point Injections
    • Cervical Dystonia and Torticollis
    • Neuromodulation
    • Infusion Therapy
    • Clinical Trials
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    • Financial Policy
    • Patient Portal
    • Pay My Bill
    • Medication Refill
    • Patient Forms
    • Guide to Healthy Living >
      • Lifestyle Management >
        • Behavioral Treatments
        • Weather Changes
      • Eating and Exercise >
        • Eating Healthy
        • Exercise
        • Alcohol and migraine
        • Caffeine and Migraine
        • Dietary Supplements
      • Sleep Hygiene >
        • Sleep Disorders
        • Healthy Sleeping Habits
      • Women and Migraine >
        • Menstrual Migraine
        • Pregnancy and Migraine
        • Perimenopause
      • Online Resources >
        • Headache Information
        • Headache Tools
    • Request Medical Records
    • Disability / FMLA
    • Patient Testimonials
  • APPT REQUEST
    • Covid-19 Policy
    • Appointment Request
    • Cancel / Re-schedule My Appointment
    • Physician Referral
NASHVILLE NEUROSCIENCE GROUP
  • NNG
  • ABOUT US
  • PROVIDERS
  • HEADACHE TYPES
  • SERVICES
    • Botox® for Migraines
    • Occipital Nerve Block
    • Sphenopalatine Ganglion Block
    • Supraorbital Nerve Block
    • Trigger Point Injections
    • Cervical Dystonia and Torticollis
    • Neuromodulation
    • Infusion Therapy
    • Clinical Trials
  • PATIENT RESOURCES
    • Financial Policy
    • Patient Portal
    • Pay My Bill
    • Medication Refill
    • Patient Forms
    • Guide to Healthy Living >
      • Lifestyle Management >
        • Behavioral Treatments
        • Weather Changes
      • Eating and Exercise >
        • Eating Healthy
        • Exercise
        • Alcohol and migraine
        • Caffeine and Migraine
        • Dietary Supplements
      • Sleep Hygiene >
        • Sleep Disorders
        • Healthy Sleeping Habits
      • Women and Migraine >
        • Menstrual Migraine
        • Pregnancy and Migraine
        • Perimenopause
      • Online Resources >
        • Headache Information
        • Headache Tools
    • Request Medical Records
    • Disability / FMLA
    • Patient Testimonials
  • APPT REQUEST
    • Covid-19 Policy
    • Appointment Request
    • Cancel / Re-schedule My Appointment
    • Physician Referral
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Disabllity / FMLA / Other Requests

Pay Now!

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Email:
nng.advancedhealth@nashvilleneuroscience.com

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Fax:
615-284-4681


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Mail:
Nashville Neuroscience Group
2004 Hayes St, Suite 650
Nashville, TN 37203
Applying for Disability/FMLA Coverage

Are You Eligible?
In order for your provider to complete any forms regarding your Disability/FMLA status, you must have received treatment at Nashville Neuroscience Group within the last three months. To be eligible for disability benefits that are supported by Nashville Neuroscience Group, you must first complete at least three office visits with your current provider.

What Is Required?
For any Disability or FMLA forms to be processed and subsequently completed by your Provider, the following must be submitted to Nashville Neuroscience Group by email, fax, postal mail or in person:
  • Any disability or FMLA forms that need to be completed by your provider
  • A Disability/FMLA/Special Reports Request form
  • Headache Calendars for the past three months (not applicable for new patients requesting FMLA)
  • A signed and valid Request for Medical Records to release medical information to a third party (if applicable)
The required forms are available at our clinic or you can download them from our website.
​
Please complete the Medical Records Form if our office does not have a signed release form within the past 12 months.


What Fees Are Charged?
Before any disability and/or FMLA forms are completed by your provider, a forms fee of $50 is required for the 1st 5 pages completed. An additional $10 per page is required after 5 pages. This fee DOES NOT include the cost of sending any additional records (if requested).  This fee can be paid on the website, by phone, or in person.  No checks are accepted for payment.

The form fee applies only to basic forms and physician statements. For more detailed, multiple impairment questionnaires, the price is higher based on the number of pages. The price for a detailed narrative report is $500. This report is usually requested by an attorney.  We do not bill insurance for completion of any narrative reports, physician statements or questionnaires pertaining to Disability/FMLA.​

​How Long Does It Take?
The processing time for disability or FMLA forms is 10 – 15 business days after all necessary forms are received at Nashville Neuroscience Group. Failure to submit any of the requirements listed above will result in a delay in processing time or incompletion of forms.


A D D R E S S:
Nashville Neuroscience Group
2004 Hayes Street, ​Suite 650
Nashville, TN 37203
​Telephone (615) 284-4680
​Fax: (615) 284-4681
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HOURS OF OPERATION:
Monday - Thursdays, 8AM - 4:00 PM
Fridays, 8 am - 12 Noon
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Send us an email!

  • NNG
  • ABOUT US
  • PROVIDERS
  • HEADACHE TYPES
  • SERVICES
    • Botox® for Migraines
    • Occipital Nerve Block
    • Sphenopalatine Ganglion Block
    • Supraorbital Nerve Block
    • Trigger Point Injections
    • Cervical Dystonia and Torticollis
    • Neuromodulation
    • Infusion Therapy
    • Clinical Trials
  • PATIENT RESOURCES
    • Financial Policy
    • Patient Portal
    • Pay My Bill
    • Medication Refill
    • Patient Forms
    • Guide to Healthy Living >
      • Lifestyle Management >
        • Behavioral Treatments
        • Weather Changes
      • Eating and Exercise >
        • Eating Healthy
        • Exercise
        • Alcohol and migraine
        • Caffeine and Migraine
        • Dietary Supplements
      • Sleep Hygiene >
        • Sleep Disorders
        • Healthy Sleeping Habits
      • Women and Migraine >
        • Menstrual Migraine
        • Pregnancy and Migraine
        • Perimenopause
      • Online Resources >
        • Headache Information
        • Headache Tools
    • Request Medical Records
    • Disability / FMLA
    • Patient Testimonials
  • APPT REQUEST
    • Covid-19 Policy
    • Appointment Request
    • Cancel / Re-schedule My Appointment
    • Physician Referral