Reasonable Accommodation Request Medical Certification

Last UpdatedFebruary 10, 2021
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This form should be provided to employees to pass on to their healthcare provider in order to obtain medical certification regarding accommodation(s). Please see the Easy Steps for a full guide on the Reasonable Accommodation packet.

1612936028wpdm_ADA00002 Reasonable Accommodation Request Medical Certification.pdf
Note: This sample form is provided as a tool for employers. This form is general in nature, and may not be required by law. ManagEase is not a law firm. This form does not constitute legal advice, nor is any attorney-client relationship created or implied. Prior to using this form, we recommend that you consult with an attorney knowledgeable in any potentially applicable federal and/or state laws regarding the specific intended use of this form.
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