Important information about Coronavirus/COVID-19 and new policies in place at our practice

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OBGYN Associates of Erie has partnered with HealthMark to ensure the accurate and timely completion of FMLA and/or Disability forms.

FMLA and/or Disability forms

Requests may be submitted electronically to HealthMark’s Request Manager at

Once logged in, select “Submit Request” from the menu options and enter all required fields to submit a valid authorization. Each form requested for completion will require a $35.00 fee to be paid directly to HealthMark. Estimated turnaround time will be 48-72 hours.

If an email is provided, you will receive a response directly from HealthMark notifying you of the prepayment invoice. After payment, the completed forms may be downloaded directly through HealthMark's website, or provided directly to you through an agreed to delivery method (i.e. secure email, mail, etc.).

Start Form Request

Status Updates on Your Form Request

All Form Requests are processed by our partnering provider, HealthMark. *Please allow up to 5 business days for processing of your request, although typical turnaround for FMLA and Disability forms is 48-72 hours.

If you would like to check the status of your Request, please log into Request Manager where you can get status updates or chat with support. You can also call HealthMark at 1-800-659-4035 or email