Fitness To Study Questionnaire

 
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Student Details
Details of the Medical Condition or Disability
Is this health condition on-going? : *
Have you discussed this application with one of the doctors at the surgery already (e.g. when you requested medical suspension)? : *

Once your medical report has been completed, the practice will send it directly your college. The medical report is issued in confidence but may include information you have provided plus information from your health records that is relevant to your fitness to study medical letter request. 

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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Providing NHS Services

Beaumont Street Surgery
19 Beaumont Street
Oxford
Oxfordshire
OX1 2NA

Elms Road Surgery
Elms Road
Oxford
OX2 9JS

Telephone: 01865 240501