Follow the steps to successfully complete the questionnaire.

1. Click ‘Get Form’ button to access the questionnaire and open it in the online editor.
2. In the first section, provide the employee's name by filling in the appropriate fields: First name, Middle initial (if applicable), and Last name.
3. Next, enter the medical professional's name in the designated fields. Include the First name and any relevant initials.
4. Identify the type of practice and medical specialty of the medical professional by selecting or entering the relevant information.
5. Fill in the business address, including the City, State, and ZIP Code of the medical professional.
6. Provide the telephone number and fax number for the medical professional using the specified fields.
7. In the medical information section, identify the medical condition(s) for which accommodations are required.
8. Indicate the dates of treatment and the probable duration of the condition to provide context for the accommodation request.
9. Respond to the questions regarding whether the employee is substantially limited in major life activities, including any limitations on essential job functions.
10. Describe any functional limitations caused by the condition and their expected duration.
11. Suggest any accommodations that could assist the employee in performing essential job functions based on the medical professional’s knowledge.
12. Indicate if the employee requires leave or a reduced schedule and specify the expected duration of that need.
13. Discuss any episodic flare-ups that may affect the employee's job functions, including frequency and duration, along with necessary accommodations.
14. Provide any additional information that could assist the DFA in evaluating the accommodation request.
15. Finally, the medical professional should sign and date the form, ensuring it is complete.
16. Upon completion, users can save the changes, download, print, or share the finalized form as needed.

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