Medical Exemption Form

I agree that by signing this Medical Exemption Form that a) this student is one of my patients, b) I have seen them regarding this specific reason for exemption, and c) affirm that in my professional opinion it is best for them to live off-campus during the following semesters of their college career. Furthermore, I agree that the accommodation of a private room (either in a Residence Hall or an on-campus apartment) will not be adequate to sustain the health of my patient. *