Student medical certificate 2026

1. Click ‘Get Form’ to open the Student medical certificate in the editor.
2. In the first section, enter your student number and print your name clearly. This authorizes the licensed practitioner to share necessary information with Western University.
3. Sign and date the form to confirm your authorization.
4. The licensed practitioner will complete their section by indicating the degree of incapacitation on academic functioning. They should initial the most relevant category based on their assessment.
5. Next, they will provide the start date of your condition and an anticipated end date, detailing how it affects your academic obligations.
6. The practitioner should describe their visits regarding your illness, including dates for single or multiple visits.
7. Finally, they will verify their assessment by printing their name, registration number, signing, dating, and providing contact information.

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