Student Medical Evidence Request

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There is a £20 charge for this service.

Upon submitting your request you will be taken to the payment. If you do not complete payment your request will be delayed.

If you are unsure which route to take and therefore what evidence is required, we recommend you discuss with Student Support in the first instance. Students in severe hardship can apply for financial support from the University Support Grant for this cost.

Please contact the Admin Team before completing the form due to suitability of criteria

Please complete a DSA Evidence form which is available under the heading 'Proving you're eligible'


This will be used by your doctor to provide your medical evidence.

Personal Information (to be completed by the patient
Please double check you've entered the correct email address
Please give a brief description on the impact of this illness on studies for example on memory or motivational difficulties, anxiety or paranoia, mobility, daily living, etc.
Destination (to be completed by the patient)

For all completed requests, these will be either posted or sent via a link in a text message

Declaration (to be completed by the patient)

Privacy Consent

This form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.


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