Welcome! Thank you for choosing our online service. We are an asynchronous telemedicine platform powered by Board-Certified licensed physicians at HealthSource Medical Associates, providing you easier access to healthcare. We strive to help bridge the gaps in healthcare while encouraging you to establish care or follow-up with your primary care provider. Please note, our policy has been updated to allow only one submission per month. Please click next to proceed.

Thank you. Your Health is Important to Us.

Please be reminded this form is to help patients who tested positive for COVID-19 and are having MILD symptoms obtain a work or school excuse note.

You will be required to take a photo of your positive COVID-19 test result.

As a reminder, your note will also state your reason for staying home is due to having COVID-19. 

If you wish your note NOT to state COVID-19 as the reason, please click here to proceed with a regular doctor's note assessment.

If you are currently experiencing severe symptoms that require prompt medical attention in the Emergency Room, we recommend you go to the Emergency Room.

Severe symptoms may include:

• New facial drooping with slurred speech suggestive of a stroke
• New and severe left sided chest pain suggestive of a heart attack
• Severe difficulty breathing suggestive of respiratory failure
• Extremely high fevers with fast heart rate suggestive of sepsis
• Constant 10 out of 10 abdominal pain that may indicate an emergency and urgent surgical intervention

If there is any chance you could be pregnant, we recommend you seek in-person care for a doctor's note.

If your employer or school does not allow for telemedicine to be used for obtaining a doctor's excuse note, please be seen by a local in-person provider.

Thank you. We will need you to select your symptoms and medical condition in the next section. Please note, these will not be included in your doctor's note. 

If you need your note to specify your symptoms and/or medical condition, please complete the request change form that will be included in your email.

Under HIPAA regulations, you are not required to disclose this information to your employer, as it is your right keep this information private and confidential. Rarely, will an employer require this information from you.

Thank you. We will now need you to enter your personal information in the next section including your name, DOB, address, phone number, and email address.

We will also need you to take a selfie and a picture of your photo ID for identity verification.

The only personal information that will be included in your note will be your name and DOB.

We operate under strict HIPAA regulations. This means, all of the other personal identification information you provide us will be kept confidential and secure using the highest HIPAA compliant standards, and will not be shared.

The way your name appears below is how it will appear on the note. Please check to make sure your name and date of birth are correct.

{firstName} {lastName}

{dateOf}

If not correct, please go back and correct the information before proceeding.

Email Address Verification

We have been having issues with hotmail accounts. Please avoid the use hotmail email accounts if at all possible, thank you.

We will now need you to take a couple of photos now for identity verification.

Why do we need a selfie and photo ID?

• A selfie and photo ID match is essential for fraud prevention. It helps to insure that you are actually the person requesting the doctor's note and are authorized to use the payment method detailed on the next page.
• 
  If you prefer, feel free to cover the license or passport number for added privacy. However, please make sure the photo ID clearly shows your name and date of birth so it can be matched to the information you already provided. 

Your information will be kept confidential and secure using HIPAA compliant standards and will not be shared. Your privacy is our utmost concern.

Thank you for submitting all the information necessary for you to receive your note.

You will be recieving a signed note from one of our Board-Certified Physicians.

Please be reminded, there are no refunds once you receive our note as a secure attachment in your email. 

Before submitting your request, please make sure all information you have entered is correct.

If you are needing to make any changes to your note you can simply click on the link that will be included in your confirmation email. We will review the request and, if approved, will send you an updated note to your email. There is no charge for corrections required due to errors or typos on our part. All other changes, including any extension of dates, addition of return to work statements, and addition of diagnosis and/or symptoms will be subject to a $10 change fee.

Here are some general recommendations to help you recover from your mild illness:

• Staying well hydrated with plenty of water intake
• Getting plenty of rest
• Take over the counter medications as appropriate
• Stick to a clean simple diet high in antioxidants from naturally grown foods
• Take medications as prescribed by your medical provider

To obtain your authentic doctor's excuse note signed by one of our Board-certified licensed physicians, please proceed to the last page to submit your payment. We have partnered with Stripe to securely process your payment. Thank you.