Verification of Disability Form for Mental Health Treatment Providers 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the student's name and UNI in the designated fields. This information is crucial for identifying the student requiring accommodations.
3. Fill in the date the student was last seen and the dates of treatment with the current provider. Accurate dates help establish a timeline for evaluation.
4. Provide the current principal DSM-V diagnosis along with any additional diagnoses, including their respective dates. This section is vital for understanding the student's mental health status.
5. Indicate the current status of each condition (e.g., Active, Controlled) and detail how you arrived at your diagnosis by checking applicable methods such as clinical interviews or neuropsychological testing.
6. Assess and indicate the degree of functional limitations on most days, considering both positive and negative effects of treatments.
7. Detail specific recommendations for academic accommodations based on identified functional limitations, providing rationale for each suggestion.

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