Introduction
The medical questionnaires have been developed to complement the Table of Disabilities (TOD). Health care providers complete only the medical questionnaire sections relevant to the claimed/entitled condition(s).
The provided medical information represents a composition of the current disability and is utilized, along with other pertinent submitted medical information.
Please refer to Who can complete VAC’s medical questionnaires?
Important: Do NOT have a medical questionnaire completed until VAC gives you specific instructions about which questionnaire is required. You may also need to fill out a consent form so VAC can collect your medical information: Consent for VAC to Collect Information from Third Parties.
Questionnaires
- Activities of Daily Living
- Amputation of Upper and Lower Limbs
- Aneurysm and Embolus
- Ankle Conditions
- Bruxism, Tooth and Periodontal Conditions
- Cardiorespiratory Conditions
- Cervical Spine Conditions
- Coccyx, Pelvis and Sacroiliac Joint Conditions
- Elbow Joint Conditions
- Endocrine and Metabolic Conditions
- Esophageal and Gastroesophageal Junction Conditions
- Foot and Toe Conditions
- Fractures - Lower Limbs
- Fractures and Miscellaneous Musculoskeletal Conditions of the Chest and Upper Limbs
- General Medical Questionnaire
- Hearing Loss/Tinnitus
- Hemopoietic Conditions
- Hernias and Pilonidal Sinus Disease
- Hip Conditions
- Hypertension
- Kidney, Ureter and Bladder Conditions
- Knee Conditions
- Liver and Gallbladder Conditions
- Lower Limb Function
- Malignant Conditions
- Mandible and Maxilla Conditions
- Severe Obesity
- Neurological Conditions
- Nose, Throat, Sinus Conditions
- Obstructive Sleep Apnea
- Oral Cavity and Salivary Glands Conditions
- Osteomyelitis
- Pancreatic Conditions
- Peripheral Vascular Arterial Disease
- Psychiatric/Psychological Condition(s)
- Quality of Life (QOL) Questionnaire
- Raynaud's Disease/Phenomenon and Frostbite, Immersion Foot and Other Cold Injuries
- Sexual, Reproductive and Breast Conditions
- Shoulder and Acromioclavicular Joint Conditions
- Skin Diseases and Burn Scars
- Small Bowel, Large Bowel, Rectal and Anal Conditions
- Stomach and Duodenal Conditions
- Superficial Skin Wounds and Scars
- Temporomandibular Disorders (TMD)
- Thoracolumbar Spine Conditions
- Thumb/Finger Conditions
- Upper Limb Function
- Varicose Veins and Deep Vein Thrombosis
- Vertigo/Ear Conditions
- Visual Conditions
- Wrist Conditions