Este cuestionario le permite a un empleador determinar si un empleado sufre una discapacidad según la ADA para poder realizar una adaptación razonable.
Para su conveniencia, debajo del texto en español le brindamos la versión completa de este formulario en inglés.
For your convenience, the complete English version of this form is attached below the Spanish version.
Absolutely! You can ask your doctor’s office for assistance, or bring along a family member or friend to help you out.
Once you submit the questionnaire, your doctor will review it and discuss any needed accommodations or next steps with you.
Yes, your personal information is treated like gold and kept strictly confidential as per HIPAA guidelines.
Most people can finish the questionnaire in about 15 to 30 minutes, depending on the complexity of their health situation.
Typically, patients who are seeking accommodations due to a disability are the ones who need to fill out the questionnaire.
Filling out this questionnaire helps your doctor understand your health needs and determine what accommodations you may require.
The ADA Questionnaire for Physicians in Tucson is a set of questions designed to help doctors assess their patients’ eligibility for certain benefits under the Americans with Disabilities Act.
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Tucson Arizona Cuestionario de la ADA para médicos