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Fit-to-Work Consultation
If you require a sick leave or "Fit note" instead, please return to the start and select "Work Sick Leave" from £47.
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1
Full Name
as it should appear on the certificate
First Name
Last Name
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2
Date of Birth
*
This field is required.
-
Date
Day
Month
Year
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3
Sex
*
This field is required.
Female
Male
Prefer not to say
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4
Email
*
This field is required.
where the certificate will be delivered
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5
Phone
*
This field is required.
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6
I acknowledge that I do not hold any of the following roles for which fit-to-work notes cannot be provided: Any driving roles, motorsports drivers, HGV and bus drivers, taxi drivers, forklift drivers, ambulance drivers, crane operators, or work involving heights and scaffolding. Please confirm by selecting "I agree".
I agree
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7
Please explain why you need a fit to start/return to work letter
*
This field is required.
Minimum 20 words
0/0
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8
Your Workplace / Company name / Institution
*
This field is required.
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9
Please describe your daily work activities
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10
Do you have any pre-existing health conditions?
YES
NO
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11
Please list any underlying health issues or past medical history:
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12
Do you take any regular medications?
(Whether prescribed or purchased over the counter)
YES
NO
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13
Please list any regular medication you take, whether prescribed or over-the-counter:
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14
How far can you walk before you have to stop to catch your breath?
Few hundred yards
Up to 1 mile
Unlimited
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15
Please provide details on anything that could impact your work:
Huge
Large
Normal
Small
Ok
quote
Created with Sketch.
Ok
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16
Do you need us to complete a specific custom form required by your workplace?
If yes, you will be given the opportunity to upload this in the next slide. There is an additional fee of £10 for additional forms.
YES
NO
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17
Please upload the required form or document here
If you have any difficulty with your upload, you can skip this step and email it to us at certificates@medicalcert.co.uk
Drag and drop files here
Select files to upload
Max. file size
: 10.6MB
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18
Please attach a form of ID as proof of identification.
Accepted forms of ID include: photo of your driver's license, passport, work badge, residence permit, or military ID card.
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Select files to upload
Max. file size
: 20.4MB
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19
Terms
*
This field is required.
I agree that upon submitting my medical consultation, I acknowledge the Terms and Privacy Policy and consent to the following: I am NOT seriously unwell with any of the following symptoms: chest pain, shortness of breath, unrelenting severe headache, worsening severe abdominal pain, loss of vision, thoughts of suicide, confusion, ongoing bleeding, unable to swallow fluids or saliva, loss of limb sensation or control, facial numbness or weakness, slurred speech. I understand the questions in the questionnaire and answered them honestly. The requested letter is solely for the individual with the provided name and details. Medical Cert is not a replacement for a doctor's visit. I confirm I do not think I need to see a medical professional in person. Medical Cert is not my primary doctor or GP, and the doctor issuing my certificate may be unable to access my NHS or regular GP medical records. Medical Cert facilitates access to private medical letters and does not issue Med3 notes, which are obtainable through your NHS GP for UK government benefits. Medical Cert is unable to process refunds once a medical letter has been written and sent to you. If my symptoms persist or I have not fully recovered, I agree to consult with my regular doctor or GP for further medical advice. I consent to having this website store my submitted information so they can respond to my inquiry.
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20
End of Consultation
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21
My Products
*
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My Bag
1
My Bag
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Great Product Name
$20
Quantity:
1
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Great Product Name
$20
Quantity:
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Size:
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Great Product Name
$20
Quantity:
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Size:
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Great Product Name
$20
Quantity:
1
Size:
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ORDER SUMMARY
Total cost
GBP
Fit-to-work assessment
If we are unable to issue your certificate for any reason you will receive a full refund.
£
47.00
+
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Additional custom form
If your workplace requires any additional custom forms completed, please select this option.
£
10.00
+
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Quantity
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Medical Certificates from medicalcert.co.uk
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