FMLA Medical Certification Affidavit

Streamline FMLA Compliance with a Professional Medical Certification Form

Managing Family and Medical Leave Act (FMLA) requests requires careful documentation and compliance with federal regulations. This FMLA Medical Certification Affidavit template provides HR managers, healthcare administrators, and legal professionals with a structured, professional form to collect all necessary medical information for serious health condition leave requests.

Why Use This FMLA Certification Template?

The FMLA certification process involves gathering detailed medical information from healthcare providers, documenting treatment plans, and justifying intermittent or reduced schedule leave arrangements. This template simplifies that complex process by organizing all required information into clear sections that meet Department of Labor guidelines.

Built with Paperform, this template offers conditional logic to show relevant questions based on leave type, built-in validation to ensure complete submissions, and professional formatting that maintains the dignity of sensitive medical information. You can collect healthcare provider statements, treatment schedules, and employer information in one secure submission.

Perfect for HR Teams and Healthcare Providers

Whether you're an HR professional processing FMLA requests, a healthcare provider completing certification forms, or a legal compliance officer ensuring proper documentation, this template provides the structure needed for compliant, complete submissions. The form captures patient information, diagnosis details, treatment plans, functional limitations, and the specific justification for intermittent or continuous leave.

With Paperform's secure data handling and SOC 2 Type II compliance, you can trust that sensitive medical information remains protected. Connect submissions directly to your HRIS system, send confirmation emails to both employees and providers, and use Stepper to automate your FMLA approval workflows—routing forms to the right reviewers and tracking response times to stay compliant with FMLA timelines.

This template helps legal services firms, healthcare facilities, corporate HR departments, and professional services organizations maintain consistent FMLA documentation while reducing administrative burden and ensuring regulatory compliance.