Mental Residual Functional Capacity (RFC) Assessment Form

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

By , Attorney UC Law San Francisco
Updated by Diana Chaikin, Attorney Seattle University School of Law
Updated 10/14/2025

When you apply for disability benefits due to a mental health condition, Social Security reviews your medical records and functional limitations in order to determine your mental residual functional capacity (RFC). Your mental RFC is a set of limitations on what you can and can't do in a work setting. A typical mental RFC assessment includes whether you can do skilled, semi-skilled, or unskilled tasks, as well as whether you can work with the public, handle normal job stress, and finish your work duties on time.

Depending on how severe your mental health symptoms are, your RFC might rule out all jobs, and your application for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) will be awarded. Making sure that your mental RFC form is an accurate representation of all of your mental limitations can help you strengthen your claim for SSDI or SSI benefits and increase your chances of approval.

What Is a Mental Residual Functional Capacity (RFC) Form?

The mental RFC form is a four- to five-page questionnaire that outlines several work-related mental functions and states how well you're able to perform them. Mental RFC forms are often completed by medical consultants, consultative examiners, or medical experts, but you can ask your own doctors to fill out a mental RFC form and submit it to Social Security.

Having a doctor, counselor, or therapist who has consistently treated you fill out a mental health RFC form can improve your chances of winning your disability case. For example, your doctor can help answer important questions such as:

  • Can you work independently or with others?
  • Can you maintain concentration or focus long enough to complete tasks?
  • Do you adapt well to changes in your work routine?
  • Would you miss too many days of work due to mental health symptoms?

Your doctor's mental RFC can also help strengthen any "weak spots" in your application, such as evidence of malingering, drug and alcohol abuse, or failure to follow prescribed treatment.

Download a Mental RFC Assessment Form PDF for Your Doctor

Below you'll see a link to a PDF of our free mental RFC assessment form. You can print it out and bring it to your doctor, psychiatrist, or psychologist. Your doctor may charge you a small fee to fill out the form, but the fee is worth it. Completing the form should take your doctor about an hour.

After you give the form to your doctor, you can either follow up to make sure your doctor sends the form to Social Security, or your doctor can return it to you (or your representative) to send in. Keep a copy for yourself—having a backup of your mental RFC can be useful in case the form gets lost in the shuffle.

Download Mental RFC Assessment Form (PDF)

Print out and use our free sample mental RFC assessment form.

Sample Completed Mental RFC Forms: Depression, Anxiety, and Traumatic Brain Injury

If you'd like to see what a helpful completed disability form looks like, you can click on the images below. These example mental RFC forms highlight the kind of information that Social Security likes to see from doctors.

Example of a Mental RFC form filled out for depression.Example of a Mental RFC Form filled out for AnxietyExample of a Mental RFC form filled out for a traumatic brain injury.

Your RFC will likely be different depending on your specific limitations and mental health conditions. You can go over the blank form with your psychologist, psychiatrist, or counselor, but make sure that the form reflects your provider's opinion only—don't fill out the form yourself and have your doctor sign off. For more information, see our articles on getting your doctor's help for your disability claim and how your doctor's note can win your case.

I Provided a Mental RFC But My Claim Was Still Denied, What Now?

If you submitted a helpful mental RFC but your claim was still denied, don't give up. Most disability applicants receive a denial on their first try. Fortunately, Social Security gives you 60 days from when you got the denial letter to appeal the decision. You'll likely have to appeal two denials before you can request a disability hearing, where you'll have your best chance of getting approved for SSDI or SSI.

Disability hearings give you the opportunity to talk to an administrative law judge about aspects of your mental health that aren't always obvious on paper. While your medical records will form the foundation of the judge's decision as to whether you're disabled, being able to clearly discuss how your mental health symptoms affect your activities of daily living can persuade a judge who was previously on the fence to award you benefits.

Do I Need a Lawyer for My Mental Health SSDI or SSI Claim?

You aren't obligated to have an attorney at any stage of the disability determination process, but it's usually worth it. Claimants with mental health impairments in particular can often benefit from legal help in order to prevent damaging assumptions about mental disorders that can sink a case. Your attorney can help you keep on top of important appeals deadlines, handle communications with Social Security, and represent you at a disability hearing. Disability lawyers work on contingency—meaning they don't get paid unless you win—and many offer free consultations, so there's little risk in asking around to find a lawyer who's a good fit for you.

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