Includes:
Directions- On how to submit the form to SSA after it is complete
Physician Letter- Explains the importance of the form and why the physician is being asked to complete it.
Questionnaire- 4 pages
The Physical Functional Capacity Evaluation Questionnaire (4 pages) is an exceptional tool designed to help strenghten your SSI/SSDI claim by accurately document functional limitations in accordance with Social Security Administration (SSA) disability evaluation criteria. This well-structured and comprehensive four-page assessment provides healthcare providers with an easy-to-use format that ensures thorough documentation of a patient’s physical limitations and ability to sustain competitive employment. Whether you are applying for disability or appealing a denial, our forms will help strengthen your claim
(P) SSI/SSDI Physical General Provider Questionnaire
You are granted access to this form for a period of one (1) year for distribution to your clients only. Sharing this form on social media or distributing it to other representatives is strictly prohibited. Unauthorized use or distribution may result in the termination of access and potential legal action.