VAC medical questionnaires and other Veterans Affairs Canada forms

The Veterans Affairs Canada questionnaires and reports clinicians complete for disability benefits, the Veterans Independence Program and VAC-funded treatment.

Veterans Affairs Canada (VAC) lists 50 condition-specific medical questionnaires that confirm a diagnosis and assess it against the Table of Disabilities, for pain and suffering compensation or a disability pension. Among them are Psychiatric/Psychological Condition(s) (PEN 6248), Hearing Loss/Tinnitus (PEN 6249), Thoracolumbar Spine Conditions (PEN 6235) and Knee Conditions (PEN 6221). VAC also uses other reports, such as the Report by Medical Examiner (VAC 1319) and the mental health questionnaires for the Veterans Independence Program (VAC 1752 and VAC 1753).

Complete a questionnaire only after VAC says which one is required, and fill in only the sections relevant to the condition, or send a detailed report covering the same items. Signatures must be wet, digital or stamped; typed signatures are not valid. Each questionnaire asks whether VAC is to be invoiced, and VAC pays the health professional's invoice. All the forms are fillable PDFs in English and French. Vero Documents fills each questionnaire from the visit note and the chart; you review, sign and download it.

Veterans

Medical questionnaires for disability benefits (50 condition-specific forms)

VAC asks a health professional to complete the questionnaire for each claimed or entitled condition, to confirm the diagnosis and assess it against the Table of Disabilities for disability benefits (pain and suffering compensation or disability pension).

Completed by: Health professional authorized to diagnose within their scope. GP, specialist or NP for most conditions; physician assistants only in AB, SK, MB, NB, NS and PE. Also chiropractors (musculoskeletal), podiatrists (foot/toe), audiologists (hearing), psychologists and psychiatrists (mental health), dentists (dental), and ophthalmologists or optometrists (vision).
Format: Fillable PDF
Language: English and French

Official page How to fill it in

VAC 1416

Family Physician Assessment

Évaluation du médecin de famille

A general medical assessment VAC requests from a client's family physician: reason for referral, review of body systems, lab results (chest x-ray, Hgb, FBS, BUN, electrolytes, urinalysis), mental status and competence to handle own affairs, current therapy, allergies, diagnoses and prognosis, for VAC's health care team.

Completed by: Family physician
Format: Fillable PDF
Language: English and French

Official page PDF Version française Form details

PEN 6248

Medical Questionnaire: Psychiatric/Psychological Condition(s)

Questionnaire médical : Affections psychologiques/psychiatriques

Documents the diagnosis and severity of psychiatric or psychological conditions (e.g., PTSD) for VAC disability benefit assessment.

Completed by: Psychiatrist; registered, licensed or associate psychologist; GP; or NP. Candidate psychologists only if co-signed. Psychotherapists and clinical or professional counsellors for assessment only. Social workers are not accepted.
Format: Fillable PDF
Language: English and French

Official page PDF Version française Form details

PEN 6249

Medical Questionnaire: Hearing Loss/Tinnitus

Questionnaire médical : Hypoacousie/Acouphène

Documents a confirmed diagnosis of hearing loss and/or tinnitus for VAC disability benefit assessment.

Completed by: Audiologist, physician or NP. Hearing instrument practitioners may be accepted for assessment only, if a qualified professional diagnosed the condition earlier.
Format: Fillable PDF
Language: English and French

Official page PDF Version française Form details

PEN 6221

Medical Questionnaire: Knee Conditions

Questionnaire médical : affections du genou

Documents the diagnosis and assessment of knee conditions for VAC disability benefits.

Completed by: Physician, NP or chiropractor; physiotherapists for assessment or reassessment only
Format: Fillable PDF
Language: English and French

Official page PDF Version française Form details

PEN 6235

Medical Questionnaire: Thoracolumbar Spine Conditions

Questionnaire médical : Affections de la colonne dorsolombaire

Documents the diagnosis and functional assessment of thoracolumbar spine conditions for VAC disability benefits.

Completed by: Physician, NP or chiropractor; physiotherapists for assessment or reassessment only, not diagnosis
Format: Fillable PDF
Language: English and French

Official page PDF Version française Form details

VAC 743

Psychological Progress Report

Rapport d'évolution de la psychothérapie

The treating psychologist's progress report to VAC on psychological treatment: DSM diagnoses, sessions and missed appointments, test results, objectives met, changes to the treatment plan, and recommended further sessions.

Completed by: Treating psychologist or mental health provider registered with Medavie Blue Cross
Format: Fillable PDF
Language: English and French

Official page PDF Version française Form details

VAC 922B

Request for Extension of Treatment

Demande de prolongation du traitement

The treating provider asks for more VAC-funded treatment sessions beyond the yearly benefit-grid limits. The provider gives objective baseline measures, measurable goals and the reasons for more sessions.

Completed by: Treating health professional providing the VAC treatment benefit (the profession varies, e.g., physiotherapy-type services); the Veteran signs the certification
Format: Fillable PDF
Language: English and French

Official page PDF Version française Form details

VAC 1319

Report by Medical Examiner

Rapport du médecin examinateur

A medical examination report requested by VAC covering complaints, history, physical findings, special studies (when authorized by the VAC Medical Adviser or district authority), functional and psychosocial assessment, employability (restrictions, retraining potential) and prognosis.

Completed by: Examining physician (medical examiner) at VAC's request
Format: Fillable PDF
Language: English and French

Official page PDF Version française Form details

VAC 1752

Initial Mental Health Questionnaire for the Veterans Independence Program

Questionnaire initial sur la santé mentale pour le Programme pour l'autonomie des anciens combattants

The treating mental health provider assesses whether a Veteran's mental health condition creates barriers to housekeeping, grounds maintenance, errands or meal preparation, and recommends Veterans Independence Program (VIP) assistance.

Completed by: Treating mental health service provider: psychologist, psychiatrist, social worker or other qualified health professional
Format: Fillable PDF
Language: English and French

Official page PDF Version française Form details

VAC 1753

Follow-up Mental Health Questionnaire for the Veterans Independence Program

Questionnaire de suivi sur la santé mentale pour le Programme pour l'autonomie des anciens combattants

Follow-up reassessment by the treating mental health provider of a Veteran's continuing need for VIP assistance.

Completed by: Treating mental health service provider
Format: Fillable PDF
Language: English and French

Official page PDF Version française Form details

More Canadian forms

FederalFederal48 forms CPP and QPP disabilityFederal and Québec7 forms Disability tax creditFederal and Québec6 forms

How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms change without notice, so download the current version from the official page before you fill it in.

Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.

Frequently asked questions

Who can complete a VAC medical questionnaire?

A GP, specialist or nurse practitioner can complete most of them. Other professionals complete the ones in their scope: chiropractors for musculoskeletal conditions, podiatrists for foot and toe, audiologists for hearing, psychologists and psychiatrists for mental health, dentists for dental, and ophthalmologists or optometrists for vision. Physician assistants are accepted only in Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia and Prince Edward Island.

Who can complete the VAC psychiatric questionnaire, PEN 6248?

A psychiatrist, a registered, licensed or associate psychologist, a GP or a nurse practitioner. Candidate psychologists can complete it only if it is co-signed, and psychotherapists and clinical or professional counsellors may complete it for assessment only. Social workers are not accepted. The 8-page questionnaire documents the diagnosis and severity of conditions such as PTSD.

What does VAC need with the hearing loss and tinnitus questionnaire?

Attach an audiogram no more than 2 years old, with air and bone conduction at 500 to 8000 Hz in both ears. PEN 6249 can be completed by an audiologist, physician or NP. Hearing instrument practitioners may be accepted for assessment only, if a qualified professional diagnosed the condition earlier. As with the other questionnaires, a detailed report can replace the form.

How do I ask VAC for more treatment sessions?

Use the Request for Extension of Treatment (VAC 922B) when a Veteran needs VAC-funded sessions beyond the yearly benefit-grid limits. Give objective baseline measures, measurable goals and the reasons for more sessions; the Veteran signs the certification. The form goes to Medavie Blue Cross, which administers VAC treatment benefits. Psychologists report on ongoing therapy with the Psychological Progress Report (VAC 743).