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Click ‘Get Form’ to open the acces vr medical report form in the editor.
Begin by entering your name in the designated fields: Last, First, and Middle Initial. If applicable, include any other names under which your records may be listed.
Fill in your mailing address, including street, apartment number (if any), city, state, county, and ZIP code.
Provide your phone numbers where you can be reached. Ensure to include area codes for both numbers.
Enter your date of birth and gender by selecting the appropriate options.
Indicate your race/ethnicity by checking all that apply. If you identify as Hispanic or Latino, make sure to check the additional box.
Complete the sections regarding your disability and previous services received from ACCES-VR or other agencies.
Finally, review all entries for accuracy before signing and dating the application at the bottom of the form.

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