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DISABILITY RESOURCE CENTER

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Section 6: 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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Salem, MA 01970
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