Application Form to Request a Medical Exemption

The information which you provide on this form will be processed by Glasgow City Council (which is the “data controller” for purposes of the data protection law). A Privacy Statement explaining how we process your personal information can be found here

Application Form to Request a Medical Exemption. This is an application to request to be medically exempt from mobility assistance duties imposed on drivers under the Equality Act 2010.

Section 1. Personal Details

First Name(s)*
Surname*
Date of Birth*
Address 1*
Address 2
Address 3
Town/City*
Postcode*
Phone Number*
Email*

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Application Form to Request a Medical Exemption