Request Your Medical Letter
Simply select the sick note you need, complete the form, and choose a payment option that works for you. Once submitted, our doctor will review your details and issue your sick note, which will be sent directly to your email. It’s that simple!
Please note: Maximum sick note duration is 28 days. We cannot future date sick notes.
Medical Letter
Questionnaire
What Type of Note Do You Require?
*
Sick Leave from Work
Adjustments to Work Duties
Sick Leave from Studies
Travel & Holiday Cancellation
Pregnancy - Fit to Fly
Fit to Fly
Other
Patient Name
First Name
Last Name
Birth Date
Please select a month
January
February
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Month
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31
Day
Please select a year
2026
2025
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2023
2022
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2012
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1920
Year
Email
*
Confirmation Email
example@example.com
Contact Number
-
Area Code
Phone Number
Photo ID Verification
*
Browse Files
Drag and drop files here
Choose a file
Please upload a clear photo of ONE of the following: UK Passport, UK Driving Licence, or National ID Card. Your ID will be securely stored and only used to verify your identity for registration. We comply with GDPR and will not share your information with third parties.
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Your Workplace
Confirm the name of your Employer
*
Medical Questions
Do you have any pre-existing health conditions our doctor should be aware of?*
Yes
No
Please mention the pre-existing health conditions
*
Are you taking any regular medications?
Yes
No
Please mention the medication
*
Main reason for Medical Letter
*
Common Cold, Flu, Covid or viral symptoms
Headache / Migraine
Back or Joint Pain
Injury, Trauma or Accident
Abdominal or Period Pain
Anxiety, Stress or Depression
Other
Please describe your symptoms (minimum 5 words)
*
0/
When did your symptoms start
*
-
Month
-
Day
Year
Date
Have you sought Medical Care for these symptoms
*
Yes, from my GP
Yes, from A&E
No
What treatment was administered in A&E or by your GP
*
Certificate Period
Please be aware, we can only issue you a note to cover up to 6 weeks, after which you will need to see your GP
What period of time do you want this note to cover?
*
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Consultation Summary (for GP use only)
Patient Declaration & Informed Consent
*
I confirm that all information provided is true and accurate to the best of my knowledge.
I understand that this letter is based on a remote clinical review of the data I provide and that there are limitations compared to an in-person physical assessment.
I consent to a GMC-registered GP reviewing my medical information for the purpose of issuing this documentation.
I consent to the service contacting my NHS GP if the assessing clinician deems it necessary for my clinical safety or for verification purposes.
Telephone / video consultation required?
Yes
No
Consultation Date
-
Month
-
Day
Year
Date
Consultation Time
Hour Minutes
AM
PM
AM/PM Option
Estimated Due Date (EDD)
*
-
Month
-
Day
Year
Date
Outbound Travel Date
*
-
Month
-
Day
Year
Date
Return Travel Date
*
-
Month
-
Day
Year
Date
Will any single flight (not including stops) be longer than 4 hours?
*
Yes
No
Destination Country
*
Airline Name (if known)
Health Confirmation
Is this a singleton (single baby, not twins or multiple) pregnancy?
*
Yes
No
Have you experienced any complications in this pregnancy? (e.g. bleeding, high blood pressure, gestational diabetes, placenta praevia)
*
Yes
No
Please describe your complications
*
Are you currently experiencing any abdominal pain, tightenings, contractions, or vaginal bleeding/discharge?
*
Yes
No
Do you have any other medical conditions? (e.g. anaemia, previous blood clot, heart or lung problems)
*
Yes
No
Please describe your other medical conditions
*
Is your pregnancy otherwise healthy and progressing normally?
*
Yes
No
Please describe any concerns with your pregnancy
*
Have you had an antenatal check in line with your expected schedule confirming your baby's growth and heartbeat are normal?
*
Yes
No
Please describe what was found to be abnormal at your antenatal check
*
Have you had any complications in a previous pregnancy, or a previous preterm birth?
*
Yes
No
Please provide details of your previous pregnancy complications or preterm birth
*
Do you have travel insurance that covers pregnancy-related complications abroad?
*
Yes
No
Please ensure you have travel insurance that covers pregnancy-related complications before travelling abroad. Your fit-to-fly letter does not replace the need for appropriate travel insurance.
Have you confirmed with your airline that they accept passengers at your stage of pregnancy?
*
Yes
No
Please check with your airline before travelling. Many airlines restrict travel after 28 weeks and may require a fit-to-fly letter dated within 7 days of departure.
Pregnancy Fit to Fly Declaration
*
I confirm that all information provided about my pregnancy is accurate. I understand that this fit-to-fly letter is based on information provided remotely and does not replace obstetric review or airline medical clearance. I confirm I will obtain adequate travel insurance covering pregnancy-related complications. I understand that Dr Zarif cannot be held responsible for any medical events occurring during travel.
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