Student Mitigating Circumstances

Your Details

Please enter your details as they should appear on the certificate.

Full Name (first and last) *

As it should appear on the certificate

Date of Birth

Sex

Female

Male

Prefer not to say

Email Address *

Where the certificate will be delivered

Phone Number

Your Education

Tell us about your institution and course.

Name of Educational Institution *

Course and Year of Study

Your Medical Condition

Help our doctor understand what happened.

Main reason for the letter *

Start date of your symptoms

Condition status

Ongoing

Partially Recovered

Recovered

Please describe all your symptoms and timeline in detail *

⚠️ More detail helps our doctors issue your letter quickly. Insufficient detail may cause delays.

⚠️ Mental Health Check-in

In the past month, have you had thoughts about suicide?

Have you ever made a suicide attempt?

Are you having thoughts of suicide right now?

🆘 Please access urgent help now

Samaritans — for everyone Call 116 123 (free, 24/7)
Email [email protected]

Campaign Against Living Miserably (CALM) Call 0800 58 58 58 — 5pm to midnight every day

Papyrus — prevention of young suicide (HOPELINE247) Call 0800 068 41 41
Text 07860 039967 · Email [email protected]

NHS 111 Call 111 — they will help find the support you need

I agree to contact a mental health service today

Mitigating Circumstances

Help the doctor understand how your condition affected your studies.

Period affected — From *

Period affected — To *

Our doctors may issue a letter with altered coverage period depending on their clinical judgement.

How did the mitigating circumstance impact your ability to complete the assessment? *

Did you take any steps to attempt to complete the assessment despite the circumstances? *

What alternative solution do you propose? *

Medical History

Have you sought any medical care for this issue?

Have you sought medical care from your GP or A&E for this issue before?

Yes, from my GP

Yes, I visited A&E

No, never consulted a doctor for this before

What treatment was administered by your GP or A&E?

Do you have any underlying health issues or past medical history?

Do you take any medication?

Prescribed or purchased over the counter

Any further information that might be relevant (optional)

Medical Evidence & ID

⚠️

Documents not on this device? No problem — you can email them from your computer after completing this form. Send your files to [email protected] with your submission reference as the subject line. You'll receive your reference on the confirmation screen.

A&E Discharge Summary (if applicable) 📎 Upload A&E discharge summary PDF, JPG or PNG · Max 100MB

Medical Evidence (if available)

Photo/video of your condition, medical communications, prescriptions, test results, NHS app screenshots, etc.

📎 Upload medical evidence PDF, JPG, PNG, Video · Max 100MB · Multiple files allowed

Proof of ID

Driver's licence, passport, work badge, residence permit, or military ID card.

📎 Upload ID PDF, JPG or PNG · Max 100MB

I will send the files via email to [email protected] instead of uploading now. (Please note, our doctors will start on your case once we have received your documents.)

Review Your Details

Please check everything is correct before payment.

I have read and agree to the Terms and the Disclaimer above.

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Student Mitigating Circumstances Letter

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