Medical Clearance Request Letter
SAMPLE
Dear Mental Health Provider:
The student who has provided you with this letter has been granted a withdrawal from Virginia Tech and must receive approval by the Cook Counseling Center to reenroll. Typically, students accomplish this by obtaining treatment and having their physician or mental health professional provide appropriate documentation to the Cook Counseling Center. This documentation is reviewed for evidence that sufficient improvement has occurred and that the student’s psychological/psychiatric condition does not pose significant risk to the student’s future academic performance.
The attached form will facilitate your providing documentation of the above. It must be received and reviewed at the Cook Counseling Center prior to a student’s reenrollment. You may also provide a supplemental report. Please keep in mind that the more detail you provide, the more we will be able to rely upon your recommendation without having to request an additional clinical assessment of the student.
Once this information is received, and if you are supportive of the student’s intent to return to the university, the student may be allowed to reenroll. We very much appreciate your cooperation in supplying us with the above information at the appropriate time.
Sincerely,
Christopher Flynn, Ph.D.
Director, Cook
Counseling Center