DISABILITY TAX CREDIT

T2201 Intake

Tell us about yourself and your doctor or health practitioner so we can help with your Disability Tax Credit application.

How This Works

The Canada Revenue Agency’s Form T2201, the Disability Tax Credit Certificate, has two parts. You (or someone applying for you) complete Part A, and a qualified health practitioner completes Part B to certify the disability.

Complete this form
You’ll need the access code we gave you. The form takes about 10 minutes. You can leave out anything you don’t know, such as your SIN, and give it to us later.
We review your information
Andrew Green Law looks over what you sent and contacts you using the details you provide.
Your practitioner completes Part B
Your doctor or other practitioner is the one who certifies your condition. Tell us who they are below, and whether you are comfortable with us contacting them.

This form is general intake, not legal advice. If a deadline is close, please use the Contact page or call rather than waiting for a reply to this form.

Your access code was accepted. Please fill in the form below.

Who is applying? I am applying for myself I am applying for someone else (for example a family member or someone with power of attorney)

About the person with the disability

First name Last name

Date of birth Social Insurance Number (optional)Not needed to start. If you prefer, give it to us later by phone.

Occupation Your current job or main occupation. If you aren’t working now, give your most recent one, for example “retired nurse” or “former cashier”. The Law Society of Alberta requires us to record this. Street address Unit / address line 2

City Province Postal code

How should we reach you?

Email Phone

Preferred way to be contacted

Your doctor or health practitioner

This is the person who would complete Part B of the T2201. Add up to three if more than one person treats your condition.

About your application What are you applying for? Anything else we should know? (optional)

Your day-to-day life

These questions help us understand how your condition affects you on most days. All of them are optional. Write as much or as little as you like, in your own words. Think about your bad days as well as your good days.

Has this lasted, or is it expected to last, at least 12 months in a row? Yes No Not sure

When did this start? (optional) For example: since birth, a car accident in 2019, slowly getting worse since about 2020.

How often are you affected? All or almost all of the time (90% or more) Most of the time Some of the time It comes and goes

Compared with someone your age without your condition, how long do these activities take you? About three times as long or more, or I can’t do them at all Somewhat longer About the same Not sure

Describe a typical day, from getting up to going to bed. (optional) For example: it takes me an hour to get out of bed and dressed. I need to rest after a shower. I can’t cook, so my daughter brings meals. I spend most afternoons lying down. What are your good days and bad days like? (optional) For example: on a good day I can walk to the corner store. On a bad day, about four days a week, I can’t get out of bed without help. What help do you need from other people, devices or medication? (optional) For example: my partner helps me bathe and dress. I use a walker, a shower chair and grab bars. I need someone to come with me to appointments. What treatments or medications have you tried, and how much do they help? (optional) For example: physiotherapy for two years helped a little. Pain medication makes me drowsy, so I can’t drive. Counselling helps, but I still can’t manage on my own. How does this affect work, school, volunteering or caring for others? (optional) For example: I had to stop working in 2021. I can only work two short shifts a week. I can no longer look after my grandchildren.

Privacy and consent

How we handle your information

We collect the details on this form so Andrew Green Law can assess whether we can help with your Disability Tax Credit application and, if you become a client, prepare it. We also collect your practitioner’s contact details so that we can arrange for them to complete Part B.

Your information is stored in an access-controlled database on Cloudflare’s cloud platform, which may process data outside Canada. Your SIN and the free-text details you enter are additionally encrypted. Only Andrew Green Law can view them, and each time a record is opened it is logged.

We keep this information only as long as needed for the purpose above and our professional record-keeping obligations. You may ask to see, correct or delete your information at any time through the Contact page.

Submitting this form does not by itself create a lawyer-client relationship or guarantee that we can take your file.

I have read the above and agree that Andrew Green Law may collect and use this information for that purpose. It is okay for Andrew Green Law to contact the practitioner(s) listed above about this application.

Not sure what happens next? See How It Works.