Instructions for Submitting Your Form

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Instructions

• This site is for patients or their caregivers who need a form completed to apply for disability benefits or employer leave.
• ONLY ONE FORM is permitted per request. For EACH type of form you need completed by the clinic, you MUST submit a new and separate request on this site. For each request, upload ONE form only, pay for it, and submit it online. If you have more than one form to be processed, you must submit and pay for each form separately. Three forms - then 3 separate independent online submissions.
• IF YOU UPLOAD MORE THAN ONE FORM PER ONLINE SUBMISSION, YOUR FORM SUBMISSION WILL BE REJECTED.
• You may choose to have your form processed within 3 business days (expedited rush request) or in 7-10 business days.*
• If you do not follow the online instructions, your form request might be delayed or rejected.
• Pre-payment is required before your form can be processed.*
• The processing time begins once we have received all necessary items: a Release of Information authorization, your ID, your prepayment, and one Disability/FMLA form.*
• Once completed, your form will be made available online for you to save, print, or email as needed. At the time you place your request, you may also enter information for your form to be faxed/emailed directly to ONE third party (such as an insurance company or employer) and/or you may pick up a copy of your form in our office.
• You will need the following:
  1. A valid driver's license or other valid state-issued ID.
  2. A picture or PDF of your form ready to be uploaded**
  3. A credit/debit card to make payment*
  4. (Optional) The contact information of the recipient, if you want your completed form sent to a third party (e.g. an employer or insurance company).

Please have these items handy before you start!

* New Jersey Short Term/Temporary Disability and New Jersey Disability During Unemployment (DDU) are the only forms completed at no charge to the patient/caregiver. These forms are not eligible for expedited processing.

** You should fill out any patient/caregiver sections of your form before submitting it to Ortho NJ - Union County.

To keep you up-to-date, you will receive two text alerts - one to confirm that your request is in process and one to let you know that your request has been completed.

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