Workplace Accommodations

Select the accommodations you need and generate a formal request letter

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Select Your Accommodations

Choose from common accommodations. You can customize or add more in the form.

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accommodations

Doctor's Documentation Template

Give this template to your doctor to complete on their letterhead. This documentation supports your accommodation request.

[Date]

To Whom It May Concern:

[Patient name] is under my care for a medical condition. Due to their condition and treatment, I recommend the following workplace accommodations:

• [Specific accommodation with medical justification]
• [Specific accommodation with medical justification]
• [Specific accommodation with medical justification]

These accommodations are medically necessary and would enable [patient name] to continue performing their essential job functions. The expected duration of these accommodations is [timeframe/ongoing].

If you have questions regarding these recommendations, please contact my office at [phone].

Sincerely,
[Doctor name] [Title]
[Practice name]

© 2026 Back to Life, Back to Work for Cancer Survivors

Information is for educational purposes only

Not meant to be legal advice. Please consult with legal counsel.