Hartford form 2026

1. Click ‘Get Form’ to open the Hartford form in the editor.
2. Begin by completing Section I, which requires your personal information such as your name, leave ID, and date of birth. Ensure you sign page 3 before handing it over to your health care provider.
3. Instruct your health care provider to fill out Section II. They will need to provide detailed medical information regarding your condition, including treatment dates and any necessary follow-up appointments.
4. Once completed, ensure that your provider returns the form to you. You must submit it to The Hartford within 15 days of requesting leave.
5. Finally, review all sections for accuracy before sending the form via mail or fax as specified in the instructions.

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