Model letter to guide your Physician in writing a letter to verify your disability and reasonable accommodation needs

 

Date ___________

 

Dear ____________________,

______Consumer Name_______ has authorized me to verify his/her need for a reasonable accommodation in housing due to the presence of a disability.  In  my  professional opinion, ______Consumer Name_______  has a physical or mental disability that substantially limits one or more major life activities.  I base my opinion on  __________ (please be specific)_________ _______________.

             

As a reasonable accommodation to his/her disability, ______Consumer Name_______  needs  ____________ (physical accommodations, service requirements or other reasonable accommodations) ___________________  to assist him/her with housing?

             

I certify that the above information is based on my professional opinion, and is true and correct to the best of my knowledge.

Sincerely ,

Name (print or type) __________________________

Title: ________________________

Signature: __________________________________

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