Tania's Journey

I have found it necessary to utilize the protection provided under the Americans With Disabilities Act (ADA) to receive accommodations at work steaming from my Bipolar 1 Disorder as well as my Anxiety, Panic Disorder, and PTSD. I have also, on more than one occasion, been put on Short-Term Disability (STD) and even Long-Term Disability (LTD) because of my disorders. They always need pertinent medical information to approve ADA, STD, and LTD claims. The Form serves as a template to gather the most useful medical information for these purposes as well as your own. However, please note that if you have your Medical Professional fill it out on my site it will come to me. I will keep any and all information private in line with HIPPA, but will need to know that you need the information sent. If you have them fill it out here, please contact me so I can send it to you (You will need to answer some questions to verify it is YOUR medical information).