Student Medical Evidence Request

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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.

There is a £20.00 fee for the medical report which is payable on completion of this request. Students in severe hardship can apply for financial support from the University Support Grant for this cost.

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

DSA EVIDENCE FORM

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)
 
Declaration (to be completed by the patient)

Privacy Consent

This form collects personal and medical informanot tion 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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