‌*We are aware that some students are currently experiencing difficulties submitting this online form. If this is the case, you can submit our Initial Appointment & ILP request form with your supporting evidence, to accessability@exeter.ac.uk. Your request will then be received and processed in the usual way.*

Appointment Request Form - Disability Advice and Support

Before completing this form, please ensure that you read the following with regards to how your information may be shared with other staff within the University, and about declaring your health to the University - current students declaring a disability.

Following receipt of this form, Wellbeing Services will be in contact with you, through your University email (which will appear as from SID, the Student Information Desk), advising you of an appointment with one of our practitioners.

We will respond to you within 5 working days; if you have not heard from us within this time frame please call us on 01392 724381.

If you require urgent support, please see our information here.

First name: *
Surname: *
Pronouns:
Student Number (e.g.710045678): *
Email address *
Mobile number: *
Which campus will you study on? *
Which appointment format would you prefer?
1) Please complete the following declaration by ticking the relevant disability/health condition. You can select more than one.	Social/Communication impairment Blind or serious visual impairment Deaf or serious hearing impairment Long standing illness or health condition Mental health condition e.g. depression Specific learning difficulty e.g. dyslexia Physical impairment or mobility issues Disability, impairment or medical condition Two or more impairments Prefer not to say
2) Please describe your medical condition/physical disability/mental health or specific learning difficulty:
3) Please tick the main areas affected by your medical condition/physical disability/mental health diagnosis or specific learning difficulty:	Fluctuations in mood Fluctuating anxiety levels Concentration Motivation Confidence Energy levels/fatigue Reading speed and accuracy Note taking Organisation Co-ordination Handwriting Processing Speed Short-term memory Communication/social difficulties Physical health Attendance Heightened stress in relation to deadlines Sleep Eating and appetite Presentations Participation in class discussions Answering questions in class Establishing a routine
4) Have you had any academic adjustments previously? Please note these will not automatically continue at the University.
5) Are you currently being supported by a mental health service or practitioner (eg Doctor, psychiatrist, Community Mental Health Team or other relevant services)?
Please give further details:
Please upload any relevant medical evidence here. if you don't have supporting medical evidence or would like guidance on this, please book a Quick Query appointment by calling 01392 723 880. *
I confirm that the above information is correct to the best of my knowledge and that I have read the document ‘Declaring a Disability or Health Condition’. I will inform Wellbeing Services of any change in my circumstances. I consent to my information being shared within the University in order for the relevant support to be put in place. If you have any further queries or problems submitting this form, you can call Wellbeing Services on 01392 724 381, and our team will be happy to help. *

Book Initial Appointment Form

Book Initial Appointment Form

Appointment Request Form - Disability Advice and Support