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Leave Clarity Check

This short form helps identify your likely next step based on where you are in the leave or ADA process.

After submitting, you’ll receive:

• a link to download my free Mental Health Leave Quick Guide

• a copy of your responses

• a personal follow-up from me within a few business days

If you want brief help deciding which support option may fit, you’ll also have the option to book a 15-minute Leave Discovery Call. A booking fee applies.

This is educational guidance only, not a full case review or eligibility determination.

1. Name

2. Email

3. Is this for yourself or a family member?

Myself

Family Member (Caregiver, Power of Attorney, Guardianship)

4. Have you worked for your employer at least 12 months?

Yes

5. Where are you right now in the process?

Still working, just starting to think about this

Still working but things are getting urgent

Just submitted paperwork

I'm about to go out

I'm already out on leave

I've been denied or had a complication

I've returned to work and need accommodations

6. What are you seeking? (Select all that apply)

FMLA

Short-Term Disability

ADA Accommodations

Leave Extension

Leave of Absence Questions

7. If applicable, who is the 3rd party disability carrier?

8. What worries you most about taking leave?

Losing my job

Income interruption

Paperwork confusion

Talking to my manager

Retaliation or pushback

Something else

9. If Something Else (Fill in)

10. Have you already spoken to HR or your manager?

Not yet, haven't said anything

Yes, casually mentioned it

Yes, formal request submitted

Yes, and it did not go well

11. How long have you been dealing with this situation?

Less than 2 weeks

2 to 4 weeks

1 to 3 months

More than 3 months

12. Do you have a time-sensitive deadline?

No immediate deadline

Yes, I have a deadline coming up or may have already missed one

13. What's the situation or question you most want help thinking through?

This tool provides general educational guidance and does not constitute legal, medical, or HR advice. Completing this form does not create a client relationship. Personalized support is available through paid services.