COVID-19 Medical Information Request Form

COVID-19 Medical Information Request Form

for Medical Providers of Vanderbilt Faculty, Staff, and Other Employees

Vanderbilt University’s response to the COVID-19 pandemic is designed to sustain our important mission of education and research while maintaining the health and safety of our faculty, students and staff.

Faculty or staff whose age or health condition falls within one of the CDC High Risk Categories or who have other special circumstances may seek a workplace adjustment through the reasonable accommodation process by utilizing these forms.

Prior to completing this form -- have your healthcare provider complete this form and return to you.

Attach it below