Mental Health Evaluation Forms: What You Need for Disability, Veterans Benefits & More

Published by Benjamin Felleman, Ph.D. | Licensed Clinical Psychologist | www.drfelleman.com

If you're preparing for a mental health evaluation related to Social Security Disability, VA benefits, workplace accommodations, or a legal proceeding, having the correct documentation and forms is essential.

At California Psychological Assessment & Consultation Services, we provide clear, comprehensive psychological evaluations and help clients, attorneys, and referring professionals navigate the often complex requirements for mental health-related claims. Below, you'll find a curated list of the most commonly required forms—each linked for easy access.

🔍 Why These Forms Matter

Proper documentation:

• Ensures your evaluation is recognized by decision-making bodies like the SSA or VA

• Helps support claims for benefits, compensation, or legal outcomes

• Prevents avoidable delays caused by incomplete paperwork

We work with you to ensure these forms are accurately completed and fully integrated into your evaluation report.

📝 Mental Health Evaluation Forms by Use Case

✅ 1. Social Security Disability (SSDI/SSI)

If you’re applying for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI), the Social Security Administration typically requires:

• SSA-827 – Authorization to Disclose InformationAllows SSA to obtain your clinical and psychological records.

• SSA-3373 – Adult Function ReportCompleted by the applicant to describe how daily functioning is affected.

• Mental Residual Functional Capacity (MRFC) Form A structured form used to assess mental limitations, typically completed by an evaluator or treating provider.

🎖️ 2. Veterans Affairs (VA) Mental Health Evaluations

Veterans pursuing VA disability benefits for PTSD or other mental health concerns may need:

• VA Form 21-0781 – Statement in Support of Claim for PTSD

• VA Form 21-0781a – PTSD Secondary to Personal Assault

• Disability Benefits Questionnaire (DBQ) – Mental Disorders

• VA Form 21-4138 – Statement in Support of Claim

We specialize in providing detailed DBQs and mental health evaluations that meet VA documentation standards.

🛡️ 3. Private Disability Insurance

Private insurers often require:

• Attending Physician Statement (APS) – Provided by the insurer and completed by your provider

• Proprietary Behavioral Health Claim Forms – Often insurer-specific

• HIPAA-Compliant Release of Information – Enables your provider to communicate with the insurance company

We offer independent disability evaluations for private insurers and provide assistance with medical necessity and functional capacity documentation.

🏢 4. Workplace Accommodations & FMLA

Employees seeking reasonable accommodations or medical leave may need:

• ADA Accommodation Request Form – Provided by your employer and completed by a clinician

• FMLA WH-380-E – Certification of Health Condition – Documents a serious mental health condition requiring job-protected leave

We assist clients in obtaining clinical support letters and employer-ready documentation for ADA and FMLA claims.

⚖️ 5. Legal and Educational Evaluations

For court-related, forensic, or academic purposes, you may also encounter:

• Court Orders or Subpoenas – For mandated psychological evaluations

• Psychoeducational Consent and Authorization Forms – For testing related to psychological disorders

We provide forensic and educational evaluations that are responsive to legal and institutional requirements, including court testimony when needed.

📋 How to Prepare

To ensure a smooth evaluation process:

• Bring any pre-filled forms or employer/agency requests to your appointment

• Complete personal sections of forms ahead of time

• Know where results or forms need to be submitted (e.g., SSA, VA, attorney, HR)

👨‍⚕️ About Benjamin Felleman, Ph.D.

Dr. Felleman is a clinical psychologist with over a decade of experience in psychological assessment and forensic evaluation. He provides expert-level documentation for:

• Disability and benefit claims

• Veterans and service-connected conditions

• Legal proceedings and court evaluations

• Workplace and academic accommodations

📞 Schedule Your Evaluation or Consultation

Whether you’re applying for benefits, seeking workplace accommodations, or involved in legal proceedings, we can help ensure your documentation is complete and clinically sound.

👉 Contact us or visit www.drfelleman.com to get started.