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Your Doctor Could Win Your Case

Ask your treating doctor to fill out the free Medical Source Statement below for your condition. Scroll down or search to find yours.

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These forms are for your doctor to complete — not you. A Medical Source Statement only helps your Social Security Disability claim when it is filled out by a medical professional who has actually examined and treated you, based on your real treatment records. Print the form for your relevant condition(s) and bring it to your next appointment, or send it to your doctor's office in advance.

Try searching a symptom or common term — not just the medical name.

Short-Form Versions

Condensed one-page versions of the Physical and Mental forms above, for doctors with limited time.

Physical Impairments — SHORT Form

PDF Form ↓

Mental Impairments — SHORT Form

PDF Form ↓

Child (Minor) Forms

For SSI claims filed on behalf of a child under 18.

Child Functional Assessment

Word Form ↓

Child Mental Functional Assessment

Word Form ↓

Forms by Condition

33 condition-specific Medical Source Statements, grouped by body system.

No forms match that search. Try a different term, or use the Physical or Mental form above — they cover most functional limitations regardless of diagnosis.

Neurological

Autism

Word Form ↓

Headaches / Migraines

Word Form ↓

Multiple Sclerosis

Word Form ↓

Parkinson's

Word Form ↓

Peripheral Neuropathy

Word Form ↓

Seizures

Word Form ↓

Stroke

Word Form ↓

Musculoskeletal & Spine

Arthritis

Word Form ↓

Cervical Spine (Neck)

Word Form ↓

Lumbar Spine (Back)

Word Form ↓

Fibromyalgia

Word Form ↓

Muscular Dystrophy

Word Form ↓

Cardiac & Pulmonary

Cardiac

Word Form ↓

Pulmonary Disorder

Word Form ↓

Cancer

Cancer

Word Form ↓

Post-Cancer

Word Form ↓

Autoimmune & Rheumatologic

Auto-Immune Disorder

Word Form ↓

Digestive & Urological

Crohn's / Colitis

Word Form ↓

Bladder Problem

Word Form ↓

Interstitial Cystitis

Word Form ↓

Endocrine & Metabolic

Diabetes

Word Form ↓

Infectious & Immune

Ear, Skin & Sleep

Meniere's Disease

Word Form ↓

Skin Disorders

Word Form ↓

Sleep Disorders

Word Form ↓

Vision

Vision

Word Form ↓

Why These Forms Matter

A Medical Source Statement (MSS) is the single most influential piece of evidence in most Social Security Disability cases. It translates your medical records into the specific functional limitations — how long you can sit, stand, concentrate, or stay on task — that actually decide whether you qualify for benefits.

How Social Security Weighs These Forms Today

For claims filed on or after March 27, 2017, Social Security no longer gives automatic "controlling weight" to a treating doctor's opinion just because they are the treating doctor. Under the current rules (20 C.F.R. § 404.1520c), an Administrative Law Judge evaluates every medical opinion — treating, examining, or reviewing — using the same two most important factors: supportability (how well the doctor backs up the opinion with objective findings and treatment notes) and consistency (whether the opinion lines up with the rest of the medical record). A form that is well-supported and consistent with the file carries real weight. One that isn't, doesn't — regardless of who signed it.

Why Checkbox-Only Forms Fall Short

A form filled out with checkboxes alone — "mild," "moderate," "severe" — gives a judge very little to work with under the supportability factor. It states a conclusion without showing the medical basis for it. The most persuasive statements pair each checked box with specific findings: exam results, imaging, lab values, medication response, and the doctor's own treatment notes. Ask your doctor to write in the blank spaces, not just check boxes.

The Two Questions That Matter Most

Two questions on these forms tend to carry more weight than any diagnosis: how much of the workday would this person likely be off-task, and how many days per month would they likely be absent entirely. Vocational experts routinely testify that being off-task more than roughly 10–15% of the workday, or missing two or more days a month on an ongoing basis, generally rules out sustained full-time competitive employment. A form that speaks to these two questions in concrete, doctor-observed terms is often more valuable than one that only lists symptoms.

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