Medical Documentation Form

Use this form to provide documentation from an appropriately-licensed medical provider. Students are required to provide documentation which supports their accommodation request in order to have their request reviewed. The form is to be completed by the student and the medical provider. If you have any questions about how to use this form, please contact Disability Services at 563-387-1481. Completed forms should be sent to [email protected] or faxed to 563-387-1411.