Request for medical evidence

This form can be used to request a medical report which can be used to apply for special considerations.

It can also be used to request documentary evidence of a disability/condition so that the university can put in place reasonable adjustments (including for exams). You may also be able to use this for a DSA (Disabled Student’s Allowance) application.

If you are seeking documentary evidence for a new illness/condition/disability, you will need to have previously seen a GP about it.

Please note: if you are requesting Disabled Students' Allowance, you need to apply on the Government website.

You have asked us to email your report to a given address.

We must inform you that email is not secure and there is a possibility that this method can be hacked or otherwise intercepted.

You will have 21 days in which to review your report at reception.

To review the report, simply attend reception and ask to see a copy.

If you fail to review it within these 21 days, it will be sent to the email address you nominated anyway.

The provision of a medical report is not an NHS service.

Therefore the practice charges a fee of £25 to cover the administration time, doctor time and insurance needed for such independent services.

1. I understand that a fee is payable for the medical report as this is not an NHS service. I am willing to pay the required fee.

2. I agree to the release of medical information from records held by my GP.

3. I understand the completion time for reports is 28 working days from the date this form is received.

4. I understand that if I wish to see the report before it is sent, I must do so within 21 days otherwise the report will be sent.

5. I understand that a false claim of ill health used to influence the assessment of my University work will result in the imposition of penalties which may include termination of my programme.