TESTING ACCOMMODATION LETTER

[Practice name]
[Address]
[Phone and email]

Date: [Date you sign the letter]

To: [Testing body's accommodations or disability services office]
Re: [Candidate's full name]
Date of birth: [Date]
Exam: [Exam name and format, e.g. computer-based, paper, or clinical stations]
Test date or window: [Date or registration window, if known]
Candidate ID: [The testing body's ID or request number, if any]

[Candidate name] asked me for this letter to support an accommodation request, and agreed to the health information in it. [For a minor: their parent or guardian also agreed, following the law where you practise.]

MY ROLE
I am [candidate name]'s [treating physician, specialist, nurse practitioner, or psychologist]. I have known them in this role since [month and year].
Last examined: [Date, in person or by video, with where each of us was]

DIAGNOSIS AND HISTORY
Diagnosis: [The specific diagnosis, in definite terms]
First diagnosed: [Month and year, and on what basis: examination, tests, or criteria]
Course: [Permanent, long term, episodic with how often it flares, or temporary with an expected recovery date]
Treatment: [Current treatment and medications, and any side effects that matter during a test]

LIMITATIONS ON TEST DAY
[What the condition limits during this exam, with how often and for how long, e.g. needs to check and treat low blood sugar, or urgent washroom visits several times an hour]
Under standard conditions: [What would happen without accommodation]

RECOMMENDED ACCOMMODATIONS
1. [Accommodation, with the exact amount: minutes of break, percent of extra time, or the item]
Reason: [The limitation it addresses, and how]
2. [Accommodation, with the exact amount]
Reason: [The limitation it addresses, and how]
Not recommended: [Accommodations considered and not needed, e.g. extra time; otherwise delete this line]

PAST ACCOMMODATIONS
[Accommodations used at school, at work, or on earlier exams, with dates; or none, and why they are needed now]

I examined [candidate name] myself and am not a family member. The testing body decides which accommodations to approve. For questions about this letter, call [practice phone].

[Your name, credentials, specialty]
[License or registration number, and where you are licensed]
[Signature]