We need the name of the parent/guardian authorized to request the FMLA certificate on behalf of the patient in order to approve requests on behalf of someone else.
Please provide the name of the person you are requesting the certificate on behalf of.
The legal parent or guardian of the patient (if the patient is a minor), OR
The legally authorized representative (such as someone with power of attorney or other legal authority) for the patient (if the patient is an adult)
and have the authority to make this request.
I agree
I understand
Note: Patient's under the age of 18 will need a guardian to be the point of contact for our healthcare providers.
We’ll help you get clarity on what to do next.
The next few questions will determine if you meet the above requirements.
This determines your eligibility for FMLA.
This is roughly 24 hours per week on average and determines your eligibility for FMLA.
You work for a covered employer, and meet job history requirements. You are eligible for FMLA.
Next, we will determine if you have a qualifying condition.
Please have your parent or legal guardian complete this request form.
You must have worked with your employer for at least one year, a minimum of 1250 hours, and your employer must have 50+ employees.
This will help determine if you have a qualifying condition.
This will help us determine whether you meet the criteria of "serious health condition" for FMLA.
If yes, we recommend you seek help elsewhere immediately. Trust Medical is not qualified to assist you in this situation
A single overnight stay in a hospital qualifies as a serious health conditon.
Even if you haven't been to the healthcare provider recently, most conditions still qualify. We can help establish the documentation you need.
If you have been incapacitated for three or more days and received treatment this also may qualify as a serious health condition for FMLA.
If so, this may qualify as a serious health condition for FMLA.
Based on your answers, you qualify for FMLA.
Don't worry if you're not sure - we will help you determine the best option during your consultation
No worries if you're not sure - a healthcare provider experienced with FMLA will guide you on the process.
We'll match you to a healthcare provider with the right availability that meets your timeline.
Your FMLA Certification Includes:
We can help with all required employer FMLA forms. Once you book your consultation we'll give you the option to upload them to our patient portal.
The WH380 is the standard federal FMLA request form, and is accepted nationwide. If your employer did not provide you forms, we'll use the WH380.
TrustMedical is the only FMLA service that offers a 100% money back guarantee if you run into issues with your certification for any reason.
Did you know less than .01% of certifications written by our medical team are rejected?
Our process is compliant with all federal FMLA laws and guidelines. Our team has helped thousands of patients just like you.
A service you can trust!
Received forms fast, no issues!
So grateful this service exists.
They know what they are doing
We'll match you to a healthcare provider licensed in your state.
We'll use this email to send your FMLA certification and order status updates.
We need this information to include on your forms
If you are unable to join your video call, your healthcare provider will contact you at this number to complete your evaluation.
I agree to receive automated and personalized marketing text messages from Trust Medical at the number provided. Message and data rates may apply. Consent is not a condition of purchase.
I agree to receive sms from Trustmedical.
We need this information to include in your forms.
Before you continue, please make sure your information is correct.
Full Name: @firstname1 @lastname
Date of Birth: @DOB
State: @state
Email: @email
IMPORTANT: We use this information for your FMLA certification.
What happens next:
