MEDICAL VERIFICATION FORM

Your child's doctor needs to complete and fax the Medical Verification Form below to us. The fax number is on the Form.

If your child has several doctors, then just pick the doctor most related to your child's main diagnosis.

Click below to download and print the Medical Verification Form or ask your doctor to visit this page and download the Form:

(right-click and select "Save Target As...")

Both links below are the SAME Form,
just in 2 different file formats for your convenience.

***IMPORTANT*** - This Form CANNOT be completed by the parent, and it CANNOT be faxed from the parent's home or work. The Medical Verification Form needs to be completed and faxed FROM the doctor's office. We will verify the fax number of each Form received.

 Medical Verification Form.pdf  (Adobe .pdf - 87k)
or
  Medical Verification Form.doc  (Word .doc - 153k)

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