Get Medical Inquiry Form

Filling out the Medical Inquiry Form online is an important process for individuals seeking accommodations due to disabilities. This guide will walk you through each section of the form, offering clear instructions tailored to meet your needs.

Follow the steps to complete the Medical Inquiry Form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by addressing Section A, which contains questions to determine if you or the employee has a disability. Answer the first question regarding physical or mental impairment by selecting 'Yes' or 'No'. If 'Yes', specify the impairment in the space provided.
3. Indicate whether the impairment is long-term or permanent. If it is not permanent, provide an approximate duration for the impairment.
4. Respond to whether the impairment affects major life activities by selecting 'Yes' or 'No'. If 'Yes', check all applicable activities from the list provided, such as caring for self or walking.
5. Inquire if the employee is substantially limited in any of the mentioned major life activities by answering 'Yes' or 'No'. If 'Yes', describe the limitations in the provided space.
6. Proceed to Section B to evaluate whether an accommodation is needed. Respond to questions about job limitations and specify any job functions that are being affected.
7. Explain how the limitations interfere with the ability to perform job functions.
8. Next, move to Section C, which seeks to identify effective accommodation options. Provide any suggestions for possible accommodations that could help improve job performance.
9. Finally, explain how your suggestions can enhance the employee’s job performance.
10. Complete any additional comments in Section D if necessary.
11. After reviewing the completed form, save all changes. You may also choose to download, print, or share the final document as needed.

Complete your Medical Inquiry Form online today to ensure you receive the necessary accommodations.