Secure FMLA Intake
Complete your medical intake, upload your employer paperwork and supporting documentation, and submit payment securely below.
If available, please have any employer-provided FMLA paperwork and relevant supporting medical documentation ready to upload.
Before you begin, have ready
- Employer FMLA or medical-leave paperwork, if provided
- Relevant medical records or visit notes, if available
- Dates and details of the leave you are requesting
- Your employer or HR contact information
Part 1 of 2 — Intake & Documents
Complete your medical intake and upload any available employer paperwork or supporting records.
Part 2 of 2 — Payment
At the end of the intake, you’ll continue directly to secure payment of $179.
Having trouble with the form? Open the secure intake in a new window.
Your intake, document uploads, and payment are all completed through the secure embedded form above. Please do not send medical records through ordinary email.
Review by your HawkFMLA clinician occurs at the video visit after your intake, documents, and payment are received through the secure form. Submission and payment do not guarantee that the requested leave can medically or legally be certified. If additional information is needed, we will contact you.
Need help getting started? Call or text 813-981-1634.