AccessAbility Services
GPO Box U1987
Perth Western Australia 6845
Telephone +61 8 9266 7850
Facsimile +61 8 9266 3052
Email: access.ability@curtin.edu.au
Web bit.ly/accessability-curtin
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Curtin University is a trademark
of Curtin University of Technology.
Student Name: __________________________
Student Number: __________________________
Health Professional Report:
Curtin University provides services for students with disability with the aim o
f reducing the impact of
their disability/medical condition on their studies and enabling equitable access to learning. Students
who need support or study adjustments are required to provide current documentation from a treating
health professional.
Note: Diagnosis of a specific learning disability must be accompanied by a psychological /
psychometric assessment conducted by an appropriate health professional. Further information is
available from bit.ly/accessability-curtin
The following information regarding diagnosis and impact of the student’s disability/medical condition
on their studies will be used by AccessAbility Services to provide the most appropriate support for this
student. If you have any questions please contact AccessAbility Services on +61 8 92667850.
Student consent to release/exchange information:
I ................................................... hereby give authority for .......................... …………………………
(Student’s name) (Health Professional’s name)
to release information relating to my disability/medical condition to AccessAbility Services at Curtin
University, and also give authority for AccessAbility Advisors to contact my health professional
regarding
my disability/medical condition.
Date: ....................................... Student Signature ......................................................................
Health Professional to complete:
Diagnosis or nature of disability/medical condition/s.
Please indicate whether condition is:
Permanent
Temporary
Fluctuating
Degenerative
Please indicate expected duration / review date
…… Months 1 year 2 years
3 years or longer Other
……………….
