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FMLA Forms

If you have FMLA paperwork that you need our office to fill out, you will need to fill out our FMLA coversheet to accompany your paperwork.

Please email the completed form to our office at After you have completed the form, save it to your computer and attach it in an email to our office. 

Please click here to fill out this form.

Note: If you decide to fill out these forms and then email them back to us, please be aware that you have a choice to either send documents via email (which is not protected), or you can print, complete, and return the forms on-site to our practice.

Note: There is a $20 fee for the completion of FMLA/disability paperwork.

Contact Information

Northland Women's Health Care, PC

5844 NW Barry Road, Suuite 310
Kansas City, Missouri 64154

Phone: 816-741-9122
Fax: 816-741-9665

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