Medical Certificates from medicalcert.co.uk

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Full Name* This field is required.As it should appear on your certificate

First Name

Last Name

2

Date of Birth* This field is required.

Date

3

Sex* This field is required.

Female

Male

Prefer not to say

4

Email* This field is required.where the certificate will be delivered

5

Phone* This field is required.

6

What is the medical reason for your adjustment?* This field is required.

7

When would you like work adjustments until?

Date

8

Start date of your symptoms/condition* This field is required.

Date

9

How long will you be affected by this condition* This field is required.

Indefinitely / Long-term

Acute / Short-term

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Please describe all your symptoms and timeline in detail. Please provide as much information and detail as possible.* This field is required.More detail will help our doctors issue your letter quickly. Insufficient detail may delay your letter, as our doctors may have to contact you for further clarification before issuing a letter.

20 words minimum.

0/0

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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".* This field is required.

I agree

12

Do you have any other medical documentation regarding your condition that you would like to provide?

YESNO

13

Please upload any other supporting documents

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Select files to upload

Max. file size: 10.6MB

14

Your Workplace / Company name / Institution* This field is required.

15

Please describe your daily work activities

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What work adjustments do you require?* This field is required.

17

Have you sought medical care from your GP or local A&E for your medical issue before?* This field is required.

Yes, from my GP

Yes, I visited A&E

No, never consulted a doctor for this before

18

What treatment was administered in A&E or by your GP?* This field is required.

19

Please upload photos of your A&E discharge summary, if available

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Select files to upload

Max. file size: 20.4MB

20

Please list any underlying health issues or past medical history:If none, leave empty

21

Please list any regular medication you take, whether prescribed or over-the-counter:If none, leave empty

22

Please attach a short video of you describing your symptoms (30 sec - 1 min) or photos of your condition* This field is required.

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Select files to upload

Max. file size: 97.7MB

If you do not have this to hand you can click on the save icon below and return to this form later

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Adjustment to work duties

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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. Your data is used solely for ID verification purposes and never shared.

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Select files to upload

Max. file size: 20.4MB

If you do not have this to hand you can click on the save icon below and return to this form later

25

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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My Products

My Bag

1

Work Adjustment assessmentIf we are unable to issue your certificate for any reason you will receive a full refund.
£39.00Edit
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