How to Use the FillBetter Form Completion Request Cover Page

Step 1: Complete the Cover Page With the Patient

Have the patient (or their authorized representative) complete all applicable sections of the cover page, including:

• Patient identification and contact information
• Treating physician and condition details
• Leave type or purpose of the form
• Recipient and delivery instructions
• Authorization and signature

The patient (or representative) must sign and date the authorization section to allow the form to be completed and released.

Step 2: Attach the Cover Page as the First Page

Once completed and signed:

• Place the Form Completion Request cover page as the first page
• Attach the actual form(s) that need to be completed behind the cover page
• Ensure all pages are legible and properly oriented before scanning or uploading

Step 3: Submit Through the Provider Workflow

Submit the full packet (cover page + form) through the provider's normal workflow (e.g., EHR upload or document intake process). The cover page allows FillBetter to identify the request, coordinate payment, and process the form correctly.

Step 4: Payment and Processing

• Pre-payment is required prior to form completion
• After submission, FillBetter will contact the patient with available payment options
• Processing typically takes 1–3 business days after all required information and payment are received

Important Notes

• Incomplete or unsigned cover pages may delay processing
• The healthcare provider remains responsible for reviewing and submitting the completed form
• The cover page is for administrative coordination and authorization only