Mental Residual Functional Capacity (RFC) Assessment Form

Here is a mental RFC form for your doctor to fill out (a mental medical source statement).

When you apply to Social Security for a mental health condition, a claims examiner who works at Social Security will fill out a mental residual functional capacity (RFC) form. This form says what types of tasks you can and cannot do.

If you can have your own doctor fill out a similar form and submit it to Social Security, the claims examiner needs to use it in developing your RFC.

Below you'll see a link to our free mental RFC assessment form. You should print out and bring to your doctor, psychiatrist, or psychologist.

Your doctor may charge you a small fee to fill out the form, but it is worth it; it will take the doctor about an hour to complete.

After you give the form to your doctor, make sure you follow up to make sure the doctor sends the form to Social Security. Ask for a copy for yourself.

Download Mental RFC Assessment Form

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