Disability Extension Form

A Disability Extension form is a document which enables a patient to draw benefits from the state or from the workplace like extended leave, financial assistance etc. A patient who has a physical or mental disability may apply for such an extension.

The Disability extension form includes full details of the patient’s medical condition which is compiled by a trained medical officer. The form should be prepared in such a way so as to include all necessary details required for granting disability extension. Below is a sample of Disability Extension form.

The sample Disability Extension template is available online in Microsoft Word and Editable PDF formats.

Disability Extension Form

Disability Extension Form sampleDownload Easy to Edit Disability Extension Form at only $3.00

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