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Workplace Accommodation Letter Template
A workplace accommodation letter tells an employer what your patient’s health condition limits at work, what change would help, and for how long. Copy the template, see a remote-work and a sit-stand desk example, and check what employers can ask you for, place by place.
- Free, no account needed
- Word and text downloads
- Two filled examples
Blank workplace accommodation letter template
FreeWORKPLACE ACCOMMODATION LETTER [Practice name] [Address] [Phone and email] Date: [Date you write the letter] To: [Employer, human resources, or occupational health contact] Re: [Patient's full name] Date of birth: [Date] Job title: [Job title] Reference: [Request or file number, if the employer gave one] [Patient name] asked me for this letter and agreed to the information in it. MY ROLE I am [patient name]'s [family physician, psychologist, or other role]. I have treated them since [month and year] and last assessed them on [date], [in person, by video, or by phone]. HEALTH CONDITION [Patient name] has a [physical or mental health condition, or its general type] that is [ongoing, temporary, or episodic]. It limits [the activities it limits, e.g. standing, sleeping, concentrating]. Diagnosis: [Only with the patient's consent; otherwise delete this line] FUNCTIONAL LIMITATIONS [What they can't do at work, or can do only with difficulty, in numbers where you can, e.g. can't sit for more than 30 minutes at a time] Effect on the job: [The tasks or conditions it makes harder, e.g. the commute, an early start, standing at a counter] ACCOMMODATION RECOMMENDED [The change, and how much, e.g. work from home 3 days a week, a sit-stand desk, a 10 a.m. start, time off for weekly appointments] How it helps: [One line linking the change to the limitation] Other options that may also work: [Alternatives, or none known] DURATION AND REVIEW Expected to be needed: [Weeks or months, long term, or not yet known] Review date: [When I will reassess and update this letter] EMPLOYER'S QUESTIONS [Each question the employer asked about this condition and the job, with a short answer; otherwise delete this section] I have shared only the information needed for this request. For questions about this letter, call [practice phone]. [Your name, credentials] [License or registration number] [Signature]
Use it for
- Work from home or hybrid days
- Sit-stand desks and seating
- Changed hours or start times
- Mental health accommodations
- Answering an employer’s questions
Two filled examples. Every part, filled in.
Each one follows the template. Use them to judge how much detail every part needs.
Accommodation letter example: remote work 3 days a week
Family practice, follow-up visit; letter to the employer’s human resources team
Role and consent
I am the family physician of this 34-year-old payroll analyst and have treated her since March 2022. I assessed her in person on Wednesday, October 14, 2026. She asked for this letter and agreed to what it says.
Health condition
She has a mental health condition that began this spring and is being treated. I expect it to improve over the next few months. The diagnosis is not included, at her request.
Functional limitations
At present she can concentrate only for short stretches in a busy, noisy space, and her symptoms are worst on her 70-minute commute by crowded transit, after which she needs time to settle before she can work. In a quiet room, she can focus for normal periods.
Accommodation recommended
Work from home 3 days a week, with 2 days in the office. This removes most of the commute and gives her quiet time for focused work, while she keeps in-person days with her team. If remote days don’t suit the job, a quiet workspace on office days and a start time outside rush hour may also help.
Duration and review
For 12 weeks, from Monday, October 19, 2026. I will reassess her by Monday, January 11, 2027, and update this letter or confirm it is no longer needed.
Signed
Family physician, with credentials, license or registration number, and signature, on practice letterhead, with the practice phone number for questions. Issued October 14, 2026.
Accommodation letter example: sit-stand desk and hourly breaks
Family practice, in-person visit; reply to the employer’s accommodation questionnaire
Role and consent
I am the family physician of this 52-year-old accounts payable clerk and have treated her for 9 years. I assessed her in person on Tuesday, October 20, 2026. She signed a release for me to answer her employer’s questionnaire dated Thursday, October 15, 2026.
Health condition
Chronic low back pain, present for 3 years and expected to be long term. Included at her request, because she wanted her manager to understand the need.
Functional limitations
She can sit for about 30 minutes, or stand for about 20, before her pain builds. A few minutes of walking or changing position relieves it. Her desk work needs no lifting limits.
Accommodation recommended
A sit-stand desk, so she can move between sitting and standing as she needs, and a 5-minute break every hour to walk or stretch. A chair with adjustable lower-back support would also help.
Employer’s questions
Permanent or temporary: long term; I expect her to need the desk and breaks for at least the next year. Essential duties listed: she can do all of them with these accommodations. Effect of treatment on her work: none. The form also asked for her full treatment history. I have not answered that question, because it isn’t needed to decide the accommodation.
Review and signature
I will review the limitations at her next visit, within 6 months, and send an update if they change. Signed by the family physician, with credentials and license or registration number, on practice letterhead. Issued October 20, 2026.
What employers can ask you for. Checked October 2026.
Disability and human rights rules set what an employer can ask a clinician to confirm when a worker asks for an accommodation. These sources say what the letter should cover and what it can leave out. For other places, check the human rights or civil rights agency there.
United States, federal
When a disability or the need for an accommodation isn’t obvious, an employer may ask for reasonable documentation: only what is needed to show that the person has an ADA disability and needs an accommodation. In most situations it can’t ask for complete medical records, and if there is more than one disability, it can ask only about the one that needs accommodation. It may require the documentation to come from an appropriate professional, such as a doctor, psychologist, nurse, physical or occupational therapist, or licensed mental health professional.
United States, mental health providers
Give an employer medical information only if your client asks you to and signs a release, and don’t simply send records. A helpful letter explains in plain language your qualifications and relationship with the client, the nature of the condition, its functional limitations without treatment, why changes at work are needed, and any accommodation you suggest, without overstating the need for it. If the client asks you not to disclose the diagnosis, the general type of disorder, such as “an anxiety disorder,” may be enough.
California
Employers can’t ask for medical documentation when the disability or the need for the accommodation is obvious. Their own certification or inquiry forms must not ask for more than the law allows, including medical records, specific diagnoses, or what caused the disability. This applies to private employers with 5 or more employees, and all public employers.
Ontario
A person asking for accommodation is generally expected to show that they have a disability, its limitations or needs, whether they can do the essential duties with or without accommodation, and the type of accommodation needed. Employers generally aren’t entitled to the cause, diagnosis, symptoms, or treatment, unless these clearly relate to the accommodation or the needs are complex, challenging, or unclear. Saying only “stress” or “pain” may not be enough; doctors should make clear that the symptoms relate to a disability.
Alberta
For an accommodation request, the medical information must at least certify that the employee is diagnosed with a disability, its general nature, and the nature, scope, and duration of the restrictions and limitations; ideally, it sets out the accommodations needed. Employers have no right to the diagnosis, except in limited cases, or to phone the employee’s doctor without the employee’s consent.
Canada, federally regulated employers
Employers aren’t entitled to the worker’s specific diagnosis or treatment plan, except in exceptional circumstances, such as a potential threat to the worker or others. They should ask the health care provider specific questions tied to the job: the restrictions, whether they are permanent, temporary, or recurring, the accommodations needed, and the prognosis. They should also be open to information from other providers, such as nurse practitioners, psychologists, physiotherapists, and occupational therapists.
What goes in each part.
Your role and consent
Who you are to the patient, and that they asked for the letter. The employer weighs the letter by how well you know the patient.
- Your role, such as family physician or psychologist
- How long you have treated the patient, and when you last assessed them
- In person, by video, or by phone
- That the patient asked for the letter and agreed to what it says
Avoid: Writing to the employer, or answering its questions, before the patient has agreed in writing.
Health condition
The general nature of the condition, so the employer knows the request rests on one. Usually not the diagnosis.
- A physical or mental health condition, or a general type, such as “an anxiety disorder”
- Whether it is ongoing, temporary, or comes and goes
- The activities it limits, such as standing, sleeping, or concentrating
- The diagnosis, only with the patient’s consent
Avoid: “Stress” or “pain” on its own, with no link to a health condition. Say that the symptoms come from one, and what they limit.
Functional limitations
What the patient can’t do at work, or can do only with difficulty. This is the part the employer acts on.
- Limits in numbers where you can: sits for 30 minutes, stands for 20
- The tasks or conditions the limits make harder, such as the commute or an early start
- How the patient is now, with treatment, and during a flare if symptoms come and go
- The job as the patient described it, if the employer sent no description
Avoid: Symptoms, test results, or treatment in place of function. Say what the patient can’t do.
Accommodation recommended
The change you think would help, and how it meets the limitation. The employer decides how to meet the need.
- The change, and how much: days at home, hours, breaks, or equipment
- One line on how it helps with the limitation
- Other options that would also work, if you know of any
- Time for treatment, such as a weekly appointment, if needed
Avoid: Insisting on one option, or ruling on whether the job can be done from home. Those are the employer’s decisions.
Duration and review
How long the change is likely to be needed, and when you will look at it again.
- Weeks or months, long term, or not yet known
- The date you will reassess
- That you will update the letter if the limits change
Avoid: An open-ended letter. Even for a long-term condition, give a review date.
Employer’s questions
If the employer sent a form or a list of questions, answer each one about this condition and the job. If not, delete the section.
- Each question, with a short answer
- Whether the patient can do the essential duties listed, with or without the accommodation
- Whether permanent, temporary, or recurring, and whether treatment affects the work, if asked
- Any question you left unanswered, and why
Avoid: Attaching chart notes or records, or answering about other conditions. Share only what the request needs.
Signature and contact
Your details, so the employer knows who wrote the letter and where to ask about it.
- Your name and credentials
- Your license or registration number
- Your signature, and the date
- A practice phone or email for questions
Avoid: Discussing the patient beyond the letter when the employer calls. Check with the patient first.
Common mistakes, and how to avoid them.
The diagnosis by default
Employers usually need the limitation and the change, not the diagnosis. Give the general nature, such as a mental health condition, unless the patient agrees to share more.
Symptoms with no link
“Stress” or “back pain” on its own may not show that the patient needs an accommodation. Say that it comes from a health condition, what it limits, and how that affects the job.
Making the employer’s decision
Whether the job can be done from home, and which option to use, is for the employer to decide. Describe the need, suggest what would help, and don’t overstate it in case an alternative is needed.
Sending the chart
Records and therapy notes hold far more than the employer needs. Write the letter, answer only the questions about the condition that needs accommodation, and attach nothing else.
No review date
Say how long the change is likely to be needed, and when you will review it, even for a long-term condition.
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Frequently asked questions.
What should a workplace accommodation letter from a doctor include?
Your role and how long you’ve treated the patient, that they asked for the letter, the general nature of the condition, what it limits at work, the change that would help and how, and how long, with a review date. Sign it with your name, credentials, and license or registration number. Leave the diagnosis out unless the patient agrees.
Is a reasonable accommodation letter the same thing?
Yes. “Reasonable accommodation” and “duty to accommodate” are the terms many laws use for a change at work because of a health condition. Your letter supports the request; the employer weighs it and decides how to meet the need.
Does an accommodation letter need the diagnosis?
Usually not. In many places, employers are entitled to the limitations and the accommodation needed, and rarely to the diagnosis; the general nature, such as “a mental health condition,” is often enough. Include the diagnosis only if the patient agrees.
Can a doctor’s note make an employer allow working from home?
No. Your letter explains what makes on-site work hard and how remote days would help; the employer decides whether the job can be done from home, and may offer another option that works. Say how many days, for how long, and when you will review it.
How do I write a doctor’s note for a standing desk?
Give the limitation in numbers, such as sitting for no more than 30 minutes at a time, and the change: a sit-stand desk, and breaks to change position. Add how long it will be needed and a review date.
What should a mental health accommodation letter say?
Your role and how long you’ve seen the patient, the general nature of the condition, what it limits at work, such as concentration or an early start, and the change that would help. Leave out therapy content, history, and records.
Show all questions
How do I answer an employer’s medical questions?
With the patient’s written consent, answer only the questions about the condition that needs accommodation and the job, and don’t send records. If a question asks for more, such as the diagnosis or unrelated history, say you’ve left it out and why, or ask the patient whether to answer it.
Who can write a workplace accommodation letter?
Usually the health professional who treats the condition. Depending on the place and the employer, that can be a physician, nurse practitioner, psychologist, licensed therapist, or physical or occupational therapist.
Is this workplace accommodation letter template free?
Yes. Copy it, or download it as a Word or text file. No account needed.
Can Vero write an accommodation letter from my visit?
Yes. Paste this template into Vero, and it drafts the letter from your visit, with the limits, the change you suggested, and the review date. Review and edit it, then export it to PDF or Word, print it, or email it.
More templates, and guides.
Doctor’s note template
For work or school: the visit, the dates off, the return, and any limits.
Return-to-work note template
To an employer: full or modified duties, the restrictions, how long they last, and the review date.
Medical leave letter template
To an employer or leave administrator: when the leave starts, how long it lasts, the review date, and what the return needs.
Pregnancy accommodation letter template
To an employer: the pregnancy-related limitation, the change needed at work, and how long it lasts.
Lactation accommodation letter template
For pumping or breastfeeding at work: the breaks, the space, any medical reason, and an end date.
Vero Documents
Fill an employer’s accommodation questionnaire from the visit and the chart.
Medical forms library
Disability, leave, and insurer forms, with official links and how to file.
Your template. Filled in from the visit.
Vero writes your notes and letters in the templates you choose, so you review instead of type.
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