Sample Patient Letter for Exercise and Mobility Equipment

Patient Letter

Dear x,

I am writing to request a reasonable accommodation as a person with disabilities.

I am requesting an additional bedroom for the storage and use of medical equipment. This request is made in accordance with the following HUD policies: Notice PIH-2016-02 (HA) β€œA PHA must approve requests for a larger bedroom size to permit additional bedrooms if it may be necessary as a reasonable accommodation for a household with a family member with a disability, such as for example, to accommodate the need… for medical equipment (see 24 CFR part 8).”

Due to my disabilities, I require an additional room for the following equipment that has been recommended by my doctor for the treatment of my disabilities:

  • Name of equipment, size dimensions. In order to safely and suitably operate this equipment, there must be an additional x feet of space around the equipment.
  • Name of equipment, size dimensions. In order to safely and suitably operate this equipment, there must be an additional x feet of space around the equipment.
  • Name of equipment, size dimensions. In order to safely and suitably operate this equipment, there must be an additional x feet of space around the equipment.

This equipment cannot be stored or used in other parts of the apartment because of the following: (Reasons Why Can’t Equipment Be In Another Part of the House).

The additional bedroom will also be used to perform physical therapy exercises prescribed by my doctor. These activities cannot be safely and adequately performed in living room or bedroom setting. A separate bedroom is needed for this so that I can have sufficient floor space to perform these activities, as well as to properly use physical therapy equipment.

A doctor’s form is attached confirming my need for this medical equipment and physical therapy activities.

Thank you,

Add to Letter: Sleeping in Living Room

If housing agency will place someone in the living room, letter should also include: Reasons Someone Cannot Sleep in Living Room