FGS Forms
Help us help you!
Starting Documents
After an initial consultation, your therapist may ask you to complete the forms below. Please do not complete the forms unless instructed to do so.
- Registration Form (please complete and send to Kelly Bruscia)
- Developmental History
- Telehealth Consent
Medical Records Requests
Are you a current or former client that needs their medical records? Complete the form below to request your records and get information on the process.
Additional Information on Medical Records
Below are some common questions about medical records requests. For questions or concerns outside of what is provided in the Medical Records Request Form, feel free to email us.
Cost for Medical Records
Lucy Daniels Center will charge a fee for each request at seventy-five cents (75¢) per page for the first 25 pages, fifty cents (50¢) per page for pages 26 through 100, and twenty-five cents (25¢) for each page in excess of 100 pages. Lucy Daniels Center requires that each records request have a minimum fee of up to ten dollars ($10.00), inclusive of copying costs.
Invoicing & Payment Options
Upon completion of this request, Lucy Daniels Center will determine the overall cost and submit a tentative invoice to the requesting party for approval. For payment options we accept checks and ACH payments through our Payer Express platform.
Time Frame
Requests of records will be processed and provided to clients or parties with-in a 30-day time frame.