STUDENT WELLBEING
Macquarie University
NSW 2109 Australia
ABN 90 952 801 237 | CRICOS Provider 00002J
HEALTH PRACTITIONER’S REPORT
The Accessibility Service provides support and assistance to Macquarie University students with a
disability or health condition and students who are carers of a person with a disability or health
condition. In order to receive support, the student must register with this service and provide the
University with supporting documentation relevant to their experience of the health condition(s).
This form is to be completed in full by an AHPRA registered or equivalent health professional
in the field relating to the heath condition(s).
Health Condition(s)/Disability Details
Frequency/ intensity/ duration
Other conditions/ disabilities (if applicable)
Frequency/ intensity/ duration
If medication is prescribed, please describe
any side effects which impact the student’s
ability to study
Additional comments if applicable
Likely impact on student’s studies at University
Please indicate whether the student’s disability/health condition(s) impact on the following domains
of functioning:
□ Cognition Memory/ Concentration/
Processing/ Organisation
□ Interpersonal – Interacting with other people
□ Vision – Accessing visual content
□ Physical/Mobility – Accessing and
completing tasks
□ Hearing – Accessing auditory content
□ Handwriting/typing – Physically producing
written content
□ Communication – Developing spoken or
written content
Health practitioner’s details:
All supporting documentation is stored in line with the Health Records and Information Privacy Act
2002 (NSW).
Signature of health practitioner: Date:
Yes
No
