FibroSoul – ADA Accommodation

Request Letter Template

Use this template to formally request workplace accommodations.

To Whom It May Concern,

I am writing to formally request reasonable workplace accommodations under the Americans with Disabilities Act (ADA). I have a medical condition (fibromyalgia) that substantially affects major life activities such as stamina, concentration, sleep, and pain regulation.

I remain committed to performing my job responsibilities and contributing meaningfully to my role. With appropriate accommodations, I am confident I can continue working effectively and sustainably.

I respectfully request consideration of the following accommodations (to be discussed and adjusted as needed):

• Flexible or reduced scheduling during symptom flares

• Remote or hybrid work options when available

• Additional rest breaks as needed

• Ergonomic equipment (chair, keyboard, workstation adjustments)

• Modified workload or extended deadlines during difficult periods

• Quiet or low-sensory workspace options

• Organizational or voice-to-text tools to support cognitive symptoms

  I am happy to participate in an interactive process to determine reasonable accommodations that support both my health and workplace responsibilities. I can also provide medical documentation if required.

  Thank you for your time, understanding, and willingness to support accessibility in the workplace. I appreciate the opportunity to collaborate on solutions that allow me to continue contributing productively.

  Sincerely,

  You

  Created by FibroSoul – Holistic, science-informed support for living well with fibromyalgia.