You can open the Reasonable Accommodation Letter From Doctor For Housing Template in multiple formats, including PDF, Word, and Google Docs.
Reasonable Accommodation Letter From Doctor For Housing Template Printable | Editable FormSample
Examples
[Name of the Housing Provider/Manager]
[Housing Provider’s Address]
[Housing Provider’s Email]
[Doctor’s Name]
[Doctor’s License Number]
[Doctor’s Office Address]
[Doctor’s Phone]
[Doctor’s Email]
[Date]
Request for Reasonable Accommodation
I am writing to formally request a reasonable accommodation for my patient, [Patient’s Full Name], who resides at [Patient’s Address]. This request is made in accordance with the Fair Housing Act and pertains to their disability.
[Patient’s Full Name] has been diagnosed with [specific condition] that significantly impacts [his/her/their] ability to function in everyday life. Due to this condition, it is crucial that [he/she/they] have access to specific accommodations at [his/her/their] residence to enhance [his/her/their] quality of life and ensure [his/her/their] health and safety.
I kindly request that the following accommodations be made: [List accommodations, e.g., installation of grab bars, removal of carpets, permanent parking space close to the entrance, etc.]. These accommodations are essential for [Patient’s Name] due to [explain reasons].
Attached to this letter, you will find [any relevant documentation, e.g., medical records, treatment plans, or evaluations] that support this request for reasonable accommodation.
I appreciate your prompt attention to this matter and am hopeful for a swift and favorable response to this request. If you require further information or clarification, please do not hesitate to contact me directly at [Doctor’s Phone] or [Doctor’s Email].
[Signature of the Doctor]
[Doctor’s Name]
[Title/Position]
[Name of the Housing Provider/Manager]
[Housing Provider’s Address]
[Housing Provider’s Email]
[Doctor’s Name]
[Doctor’s License Number]
[Doctor’s Office Address]
[Doctor’s Phone]
[Doctor’s Email]
[Date]
Request for Reasonable Accommodation
This letter is to officially request a reasonable accommodation for my patient, [Patient’s Full Name], residing at [Patient’s Address], due to [his/her/their] medical condition, which qualifies for protections under the Fair Housing Act.
[Patient’s Full Name] has been diagnosed with [specific condition], which impairs [his/her/their] ability to [briefly describe impact of condition on daily life]. Therefore, it is imperative that [he/she/they] receives the necessary accommodations to maintain [his/her/their] well-being.
We request the following modifications in [his/her/their] living environment: [List accommodations, e.g., allowing service animals, installation of accessibility features, etc.], as these changes will directly assist [Patient’s Name] by [explain how the adaptations will help].
Enclosed you will find documentation that validates the disability and the necessity for the requested accommodations.
Thank you for considering this request. It is crucial for [Patient’s Name] to have a safe and accessible living space, and I truly appreciate your cooperation. Should you need further information or wish to discuss this matter, please feel free to reach out to my office at [Doctor’s Phone] or [Doctor’s Email].
[Signature of the Doctor]
[Doctor’s Name]
[Title/Position]
Format
Please complete the form below to create the Reasonable Accommodation Letter From Doctor For Housing Template. All fields must be filled out to ensure a clear and complete request. We provide examples to guide you through each step. Reasonable Accommodation Letter From Doctor For Housing Template 1. Patient Information 2. Doctor Information 3. Accommodation Request 4. Medical Justification 5. Duration of Accommodation 6. Health Condition Details 7. Signature and Accreditation
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Reasonable Accommodation Letter From Doctor For Housing Template Printable | Editable FormPrintable
