Medical Source Statement (MSS) Forms

From our years of experience fighting for Social Security benefits, the Disability Warriors at Liner Legal have found that having your treating doctor(s) fill out a form called a Medical Source Statement (MSS) is one of the most important things you can do to increase your chances of being approved. 

Please find the appropriate form below, take it to your next appointment, and send it back to our office. If you need hard copies or would like us to fax the form to your provider, please call our office at (216) 282-1773 and let your Case Manager know.

General MSS Forms:

● Mental Impairment Questionnaire

● Physical Medical Source Statement

● Electronic Medical Record Request Form

Impairment Specific MSS Forms:

● Cardiac Medical Source Statement

● Crohn’s / Colitis Medical Source Statement

● Fibromyalgia Medical Source Statement

● Gastroenterology Medical Source Statement

● Headaches Medical Source Statement

● Pulmonary / Asthma Medical Source Statement

● Seizures Medical Source Statement

● Spine Medical Source Statement

● Vision Impairment Medical Source Statement