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Apply for FMLA with your Human Resource Department and Short-Term Disability with Allegiant Care.

You can find applications packets for Short Term Disability Application under the “Forms” tab on the Allegiant Care website or you may call Allegiant Care at (603) 669-4771 or 1-800-258-9732 Ext. 211 and request the form.

NOTE: The form cannot be completed online. You must print the form, and mail it to Allegiant Care; Attn: Liz Macedo; P.O. Box 4604; Manchester, NH 03108.